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penicillin G sodium

Generic Name: penicillin G sodium (PEN i SIL in G SOE dee um)
Brand Name:

What is penicillin G sodium?

Penicillin G sodium is a fast-acting antibiotic that fights bacteria in your body.

Penicillin G sodium is used to treat many different types of severe infections, including strep infections, meningitis, anthrax, pneumonia, gonorrhea, and syphilis.

Penicillin G sodium may also be used for purposes not listed in this medication guide.

What is the most important information I should know about penicillin G sodium?

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

What should I discuss with my healthcare provider before using penicillin G sodium?

You should not use this medicine if you are allergic to penicillin. Tell your doctor if you have ever had an allergic reaction to a cephalosporin antibiotic such as Ceftin, Cefzil, Omnicef, Keflex, and others.

To make sure penicillin G sodium is safe for you, tell your doctor if you have:

  • asthma or a history of allergies;

  • liver disease;

  • kidney disease;

  • heart disease;

  • if you take a diuretic or "water pill"; or

  • if you take any other antibiotics, including sulfa drugs.

Penicillin G sodium is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Penicillin G sodium can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How is penicillin G sodium given?

Penicillin G sodium is injected into a muscle or into a vein through an IV. You may be shown how to use an injection at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.

Penicillin G sodium is a powder medicine that must be mixed with a liquid (diluent) before using it. Shake the mixture well before you measure a dose. If you are using the injections at home, be sure you understand how to properly mix and store the medicine.

Prepare your dose only when you are ready to give yourself an injection. Do not use penicillin G sodium if it has changed colors or has particles in it. Call your pharmacist for new medication.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Some infections may need to be treated for several weeks. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Penicillin G sodium will not treat a viral infection such as the flu or a common cold.

If you use penicillin G sodium long-term, your blood may need to be tested to make sure the medicine is not causing harmful effects. Your kidney or liver function may also need to be tested.

Penicillin G sodium can cause false results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using penicillin G sodium.

After you have finished your treatment with penicillin G sodium, your doctor may want to do tests to make sure your infection has completely cleared up.

Store the powder medicine at room temperature away from moisture and heat.

After mixing penicillin G sodium with a diluent, store in the refrigerator and use it within 3 days. Do not freeze.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of penicillin G sodium.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include confusion, agitation, hallucinations, or seizure (convulsions).

What should I avoid while taking penicillin G sodium?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking this medication and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Penicillin G sodium side effects

Get emergency medical help if you have signs of an allergic reaction: hives, itching; feeling like you might pass out; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe stomach pain, diarrhea that is watery or bloody;

  • fever, chills, swollen glands, skin sores, muscle pain, feeling short of breath, warmth or redness under your skin, severe dizziness;

  • white patches or sores inside your mouth or on your lips;

  • easy bruising, skin rash, unusual bleeding, pale or yellowed skin, severe tingling, numbness, muscle weakness;

  • red or pink urine, dark colored urine;

  • swelling in your hands or feet;

  • muscle twitching, seizures (convulsions); or

  • signs of an electrolyte imbalance--dry mouth, increased thirst, mood changes, confusion, stomach pain, vomiting, muscle pain or weakness, lack of energy, irregular heartbeats, dark urine.

Common side effects may include:

  • mild diarrhea;

  • nausea, vomiting;

  • black or hairy tongue; or

  • pain, swelling, bruising, or irritation around the IV needle.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Penicillin G sodium dosing information

Usual Adult Dose for Pneumonia:

5 to 24 million units/day IV in equally divided doses every 4 to 6 hours

Comments:
-Dose depends on the nature and severity of the infection.

Uses: For the treatment of serious infections (septicemia, empyema, pneumonia, pericarditis, endocarditis, meningitis) due to Streptococcus pyogenes, other beta-hemolytic streptococci (including groups C, H, G, L, M), S pneumoniae, Staphylococcus species (non-penicillinase-producing strains)

Usual Adult Dose for Septicemia:

5 to 24 million units/day IV in equally divided doses every 4 to 6 hours

Comments:
-Dose depends on the nature and severity of the infection.

Uses: For the treatment of serious infections (septicemia, empyema, pneumonia, pericarditis, endocarditis, meningitis) due to Streptococcus pyogenes, other beta-hemolytic streptococci (including groups C, H, G, L, M), S pneumoniae, Staphylococcus species (non-penicillinase-producing strains)

Usual Adult Dose for Bacterial Infection:

5 to 24 million units/day IV in equally divided doses every 4 to 6 hours

Comments:
-Dose depends on the nature and severity of the infection.

Uses: For the treatment of serious infections (septicemia, empyema, pneumonia, pericarditis, endocarditis, meningitis) due to Streptococcus pyogenes, other beta-hemolytic streptococci (including groups C, H, G, L, M), S pneumoniae, Staphylococcus species (non-penicillinase-producing strains)

Usual Adult Dose for Streptococcal Infection:

5 to 24 million units/day IV in equally divided doses every 4 to 6 hours

Comments:
-Dose depends on the nature and severity of the infection.

Uses: For the treatment of serious infections (septicemia, empyema, pneumonia, pericarditis, endocarditis, meningitis) due to Streptococcus pyogenes, other beta-hemolytic streptococci (including groups C, H, G, L, M), S pneumoniae, Staphylococcus species (non-penicillinase-producing strains)

Usual Adult Dose for Endocarditis:

Streptococci or staphylococci infection: 5 to 24 million units/day IV in equally divided doses every 4 to 6 hours
Erysipelothrix infection: 12 to 20 million units/day IV in divided doses every 4 to 6 hours for 4 to 6 weeks
Listeria infection: 15 to 20 million units/day IV in divided doses every 4 to 6 hours for 4 weeks

Comments:
-Dose for streptococcal or staphylococcal infection depends on the nature and severity of the infection.

Use: For the treatment of endocarditis due to S pyogenes, other beta-hemolytic streptococci (including groups C, H, G, L, M), S pneumoniae, Staphylococcus species (non-penicillinase-producing strains), Erysipelothrix rhusiopathiae, Listeria monocytogenes

American Heart Association (AHA) and Infectious Diseases Society of America (IDSA) Recommendations:
-Native valve infective endocarditis (NVE) due to highly penicillin-susceptible viridans group streptococci (VGS) or S gallolyticus (bovis) (MIC up to 0.12 mcg/mL): 12 to 18 million units/day IV continuously or in 4 or 6 equally divided doses for 4 weeks
-NVE due to relatively penicillin-resistant strains of VGS or S gallolyticus (MIC greater than 0.12 mcg/mL to less than 0.5 mcg/mL): 24 million units/day IV continuously or in 4 to 6 equally divided doses for 4 weeks
-Prosthetic valve (or other prosthetic material) infection due to VGS or S gallolyticus: 24 million units/day IV continuously or in 4 to 6 equally divided doses for 6 weeks
-NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species (if able to tolerate beta-lactam therapy): 18 to 30 million units/day IV continuously or in 6 equally divided doses for 4 to 6 weeks

Comments:
-Recommended for patients with normal renal function
-NVE due to highly penicillin-susceptible VGS or S gallolyticus: 4-week regimen is preferred in most patients older than 65 years or patients with impaired 8th cranial nerve function or renal function; if this drug (same dose, continuously or in 6 equally divided doses) is used with gentamicin, the duration of therapy may be reduced to 2 weeks; 2-week regimen not recommended if known cardiac/extracardiac abscess, CrCl less than 20 mL/min, impaired 8th cranial nerve function, or Abiotrophia, Granulicatella, or Gemella species infection
-NVE due to relatively penicillin-resistant strains of VGS or S gallolyticus: This drug should be used with gentamicin; infectious diseases consultation recommended.
-Prosthetic valve (or other prosthetic material) infection due to VGS or S gallolyticus: This drug may be used with or without gentamicin if penicillin-susceptible strain (MIC up to 0.12 mcg/mL) but should be used with gentamicin if relatively/fully penicillin-resistant strain (MIC greater than 0.12 mcg/mL).
-NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and gentamicin (if able to tolerate beta-lactam therapy): This drug should be used with gentamicin; 4-week regimen recommended for native valve patients with symptoms of illness less than 3 months; 6-week regimen recommended for native valve symptoms greater than 3 months and for patients with prosthetic valve or prosthetic material; recommended for patients with CrCl greater than 50 mL/min
-NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a penicillin-susceptible strain that is resistant to aminoglycosides or streptomycin-susceptible/gentamicin-resistant (if able to tolerate beta-lactam therapy): This drug should be used with streptomycin; this regimen is not recommended if CrCl less than 50 mL/min prior to or during therapy or cranial nerve VIII function is abnormal.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningitis:

Streptococci or staphylococci infection: 5 to 24 million units/day IV in equally divided doses every 4 to 6 hours
Listeria infection: 15 to 20 million units/day IV in divided doses every 4 to 6 hours for 2 weeks
Pasteurella infection: 4 to 6 million units/day IV in divided doses every 4 to 6 hours for 2 weeks

Comments:
-Dose for streptococcal or staphylococcal infection depends on the nature and severity of the infection.

Use: For the treatment of meningitis due to S pyogenes, other beta-hemolytic streptococci (including groups C, H, G, L, M), S pneumoniae, Staphylococcus species (non-penicillinase-producing strains), L monocytogenes, Pasteurella multocida

IDSA Recommendations: 24 million units/day IV in divided doses every 4 hours

Duration of therapy:
-L monocytogenes: At least 21 days
-S agalactiae: 14 to 21 days
-S pneumoniae: 10 to 14 days

Comments:
-A recommended agent for infection due to L monocytogenes or S agalactiae; use with an aminoglycoside should be considered.
-Considered standard therapy for S pneumoniae infection with penicillin MIC less than 0.1 mcg/mL
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningitis -- Pneumococcal:

Streptococci or staphylococci infection: 5 to 24 million units/day IV in equally divided doses every 4 to 6 hours
Listeria infection: 15 to 20 million units/day IV in divided doses every 4 to 6 hours for 2 weeks
Pasteurella infection: 4 to 6 million units/day IV in divided doses every 4 to 6 hours for 2 weeks

Comments:
-Dose for streptococcal or staphylococcal infection depends on the nature and severity of the infection.

Use: For the treatment of meningitis due to S pyogenes, other beta-hemolytic streptococci (including groups C, H, G, L, M), S pneumoniae, Staphylococcus species (non-penicillinase-producing strains), L monocytogenes, Pasteurella multocida

IDSA Recommendations: 24 million units/day IV in divided doses every 4 hours

Duration of therapy:
-L monocytogenes: At least 21 days
-S agalactiae: 14 to 21 days
-S pneumoniae: 10 to 14 days

Comments:
-A recommended agent for infection due to L monocytogenes or S agalactiae; use with an aminoglycoside should be considered.
-Considered standard therapy for S pneumoniae infection with penicillin MIC less than 0.1 mcg/mL
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningitis -- Meningococcal:

24 million units/day, administered as 2 million units IV every 2 hours

Use: For the treatment of meningococcal meningitis and/or septicemia due to Neisseria meningitidis

IDSA Recommendations: 24 million units/day IV in divided doses every 4 hours for 7 days

Comments:
-Recommended as an alternative agent for infection due to N meningitidis
-Considered standard therapy for N meningitidis infection with penicillin MIC less than 0.1 mcg/mL
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Neurosyphilis:

12 to 24 million units/day, administered as 2 to 4 million units IV every 4 hours for 10 to 14 days

Comments:
-Many experts recommend additional therapy with penicillin G benzathine after completion of IV therapy.
-Adequate follow-up (including clinical and serological examinations) recommended for all cases of penicillin-treated syphilis; US CDC guidelines should be consulted.

Use: For the treatment of neurosyphilis due to Treponema pallidum

US CDC Recommendations: 18 to 24 million units/day, administered as 3 to 4 million units IV every 4 hours or a continuous IV infusion for 10 to 14 days

Comments:
-Recommended as the preferred regimen for neurosyphilis and ocular syphilis
-US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the IDSA (HIVMA/IDSA) also recommend this as the preferred regimen for neurosyphilis, ocular syphilis, and otic syphilis in HIV-infected adults.
-Duration of neurosyphilis therapy is shorter than the duration for latent syphilis therapy; penicillin G benzathine can be considered after completing this drug to provide comparable total duration of therapy.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Actinomycosis:

Cervicofacial disease: 1 to 6 million units/day IV in divided doses every 4 to 6 hours
Thoracic and abdominal disease: 10 to 20 million units/day IV in divided doses every 4 to 6 hours

Uses: For the treatment of actinomycosis (cervicofacial disease, thoracic and abdominal disease) due to Actinomyces israelii

Usual Adult Dose for Inhalation Bacillus anthracis:

Minimum of 8 million units/day IV in divided doses every 6 hours

Comments:
-Higher doses may be needed depending on susceptibility of organism.

Use: For the treatment of anthrax due to Bacillus anthracis

US CDC Recommendations: 4 million units IV every 4 hours

Duration of Therapy:
-With possible/confirmed meningitis: At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
-Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Comments:
-Recommended as an alternative agent for the treatment of systemic anthrax due to penicillin-susceptible strains (MIC less than 0.125 mcg/mL)
-Recommended for use with a protein synthesis inhibitor; the addition of a bactericidal fluoroquinolone is recommended with possible/confirmed meningitis.
-Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Cutaneous Bacillus anthracis:

Minimum of 8 million units/day IV in divided doses every 6 hours

Comments:
-Higher doses may be needed depending on susceptibility of organism.

Use: For the treatment of anthrax due to Bacillus anthracis

US CDC Recommendations: 4 million units IV every 4 hours

Duration of Therapy:
-With possible/confirmed meningitis: At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
-Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Comments:
-Recommended as an alternative agent for the treatment of systemic anthrax due to penicillin-susceptible strains (MIC less than 0.125 mcg/mL)
-Recommended for use with a protein synthesis inhibitor; the addition of a bactericidal fluoroquinolone is recommended with possible/confirmed meningitis.
-Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Clostridial Infection:

20 million units/day IV in divided doses every 4 to 6 hours

Comments:
-Debridement and/or surgery as indicated for gas gangrene.

Uses: For botulism (as adjunctive therapy to antitoxin), gas gangrene, tetanus (as adjunctive therapy to human tetanus immune globulin) due to Clostridium species

Usual Adult Dose for Tetanus:

20 million units/day IV in divided doses every 4 to 6 hours

Comments:
-Debridement and/or surgery as indicated for gas gangrene.

Uses: For botulism (as adjunctive therapy to antitoxin), gas gangrene, tetanus (as adjunctive therapy to human tetanus immune globulin) due to Clostridium species

Usual Adult Dose for Botulism:

20 million units/day IV in divided doses every 4 to 6 hours

Comments:
-Debridement and/or surgery as indicated for gas gangrene.

Uses: For botulism (as adjunctive therapy to antitoxin), gas gangrene, tetanus (as adjunctive therapy to human tetanus immune globulin) due to Clostridium species

Usual Adult Dose for Diphtheria:

2 to 3 million units/day IV in divided doses every 4 to 6 hours for 10 to 12 days

Uses: For diphtheria (as adjunctive therapy to antitoxin and prevention of carrier state) due to Corynebacterium diphtheriae

Usual Adult Dose for Fusospirochetosis:

5 to 10 million units/day IV in divided doses every 4 to 6 hours

Uses: For the treatment of fusospirochetosis (severe infections of the oropharynx [Vincent's], lower respiratory tract, genital area) due to Fusobacterium species and spirochetes

Usual Adult Dose for Bacteremia:

Pasteurella infections: 4 to 6 million units/day IV in divided doses every 4 to 6 hours for 2 weeks
Gram-negative bacillary infections: No specific guidelines have been suggested by the manufacturer.

Comments:
-Penicillin G is not a drug of choice for treating gram-negative bacillary infections; previously, some species of gram-negative bacilli were considered susceptible to very high IV doses (up to 80 million units/day). Other more effective agents are usually used to treat these infections.

Uses: For the treatment of Pasteurella infections (including bacteremia, meningitis) due to P multocida; for the treatment of gram-negative bacillary infections (bacteremias) due to Escherichia coli, Enterobacter aerogenes, Alcaligenes faecalis, Salmonella, Shigella, Proteus mirabilis

Usual Adult Dose for Gram Negative Infection:

Pasteurella infections: 4 to 6 million units/day IV in divided doses every 4 to 6 hours for 2 weeks
Gram-negative bacillary infections: No specific guidelines have been suggested by the manufacturer.

Comments:
-Penicillin G is not a drug of choice for treating gram-negative bacillary infections; previously, some species of gram-negative bacilli were considered susceptible to very high IV doses (up to 80 million units/day). Other more effective agents are usually used to treat these infections.

Uses: For the treatment of Pasteurella infections (including bacteremia, meningitis) due to P multocida; for the treatment of gram-negative bacillary infections (bacteremias) due to Escherichia coli, Enterobacter aerogenes, Alcaligenes faecalis, Salmonella, Shigella, Proteus mirabilis

Usual Adult Dose for Rat-bite Fever:

12 to 20 million units/day IV in divided doses every 4 to 6 hours for 3 to 4 weeks

Uses: For the treatment of Haverhill fever due to Streptobacillus moniliformis; for the treatment of rat-bite fever due to Spirillum minus or S moniliformis

Usual Adult Dose for Lyme Disease -- Arthritis:

American Academy of Neurology (AAN) and IDSA Recommendations: 18 to 24 million units/day IV in divided doses every 4 hours
Duration of therapy: 14 days

Comments:
-IDSA recommends this drug as an alternative parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease -- Carditis:

American Academy of Neurology (AAN) and IDSA Recommendations: 18 to 24 million units/day IV in divided doses every 4 hours
Duration of therapy: 14 days

Comments:
-IDSA recommends this drug as an alternative parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease -- Neurologic:

American Academy of Neurology (AAN) and IDSA Recommendations: 18 to 24 million units/day IV in divided doses every 4 hours
Duration of therapy: 14 days

Comments:
-IDSA recommends this drug as an alternative parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease:

US CDC Recommendations: 5 million units IV initially followed by 2.5 to 3 million units IV every 4 hours until delivery

Comments:
-A recommended regimen for intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease
-Use of this drug for at least 4 hours before delivery is considered adequate intrapartum antibiotic prophylaxis.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin or Soft Tissue Infection:

IDSA Recommendations: 2 to 4 million units IV every 4 to 6 hours

Comments:
-Recommended for the treatment of non-purulent skin and soft tissue infection (cellulitis)/streptococcal skin infection
-In combination with clindamycin, recommended as the preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to Streptococcus or Clostridium species
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Joint Infection:

IDSA Recommendations:
-Enterococcus species (penicillin-susceptible), streptococci (beta-hemolytic): 20 to 24 million units/day IV continuously or in 6 divided doses
-Propionibacterium acnes: 20 million units/day IV continuously or in 6 divided doses

Duration of therapy:
-Native vertebral osteomyelitis: 6 weeks
-Prosthetic joint infection: 4 to 6 weeks

Comments:
-Recommended as a preferred regimen for the treatment of native vertebral osteomyelitis and prosthetic joint infection due to penicillin-susceptible Enterococcus species, beta-hemolytic streptococci, or P acnes
-Penicillin-susceptible Enterococcus species: For patients with native vertebral osteomyelitis, aminoglycoside should be added for those with infective endocarditis and is optional for others; for patients with prosthetic joint infection, aminoglycoside optional
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Osteomyelitis:

IDSA Recommendations:
-Enterococcus species (penicillin-susceptible), streptococci (beta-hemolytic): 20 to 24 million units/day IV continuously or in 6 divided doses
-Propionibacterium acnes: 20 million units/day IV continuously or in 6 divided doses

Duration of therapy:
-Native vertebral osteomyelitis: 6 weeks
-Prosthetic joint infection: 4 to 6 weeks

Comments:
-Recommended as a preferred regimen for the treatment of native vertebral osteomyelitis and prosthetic joint infection due to penicillin-susceptible Enterococcus species, beta-hemolytic streptococci, or P acnes
-Penicillin-susceptible Enterococcus species: For patients with native vertebral osteomyelitis, aminoglycoside should be added for those with infective endocarditis and is optional for others; for patients with prosthetic joint infection, aminoglycoside optional
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Leptospirosis:

Some experts recommend: 1.5 million units IV every 6 hours for 7 days

Usual Adult Dose for Gonococcal Infection -- Disseminated:

10 million units/day IV in divided doses every 4 to 6 hours
Duration of therapy: Depends on nature and severity of infection

Comments:
-Due to resistance, penicillins are not recommended by the US CDC.
-Current guidelines should be consulted for additional information.

Use: For the treatment of disseminated gonococcal infections (such as meningitis, endocarditis, arthritis, etc.) due to penicillin-susceptible N gonorrhoeae

Usual Pediatric Dose for Bacterial Infection:

American Academy of Pediatrics (AAP) Recommendations:
7 days or younger: 25,000 to 50,000 units/kg IM or IV every 12 hours
8 to 28 days: 25,000 to 50,000 units/kg IM or IV every 8 hours

1 month or older:
Mild to moderate infections: 100,000 to 150,000 units/kg/day IM or IV in 4 divided doses
Maximum dose: 8 million units/day

Severe infections: 200,000 to 300,000 units/kg/day IM or IV in 4 to 6 divided doses
Maximum dose: 24 million units/day

Usual Pediatric Dose for Pneumonia:

150,000 units/kg/day IV in equally divided doses every 4 to 6 hours
Duration of therapy: Depends on nature and severity of infection

Uses: For the treatment of serious infections (such as pneumonia, endocarditis) due to susceptible strains of streptococci (including S pneumoniae) and meningococcus

AAP Recommendations:
-Invasive pneumococcal infections in patients 1 month or older: 250,000 to 400,000 units/kg/day IV in divided doses every 4 to 6 hours

PIDS and IDSA Recommendations:
Community-acquired pneumonia in infants and children older than 3 months:
-S pneumoniae with penicillin MIC up to 2 mcg/mL: 200,000 to 250,000 units/kg/day IV in divided doses every 4 to 6 hours
-Group A Streptococcus: 100,000 to 250,000 units/kg/day IV in divided doses every 4 to 6 hours

Comments:
-PIDS/IDSA: Recommended as preferred parenteral therapy
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Streptococcal Infection:

150,000 units/kg/day IV in equally divided doses every 4 to 6 hours
Duration of therapy: Depends on nature and severity of infection

Uses: For the treatment of serious infections (such as pneumonia, endocarditis) due to susceptible strains of streptococci (including S pneumoniae) and meningococcus

AAP Recommendations:
-Invasive pneumococcal infections in patients 1 month or older: 250,000 to 400,000 units/kg/day IV in divided doses every 4 to 6 hours

PIDS and IDSA Recommendations:
Community-acquired pneumonia in infants and children older than 3 months:
-S pneumoniae with penicillin MIC up to 2 mcg/mL: 200,000 to 250,000 units/kg/day IV in divided doses every 4 to 6 hours
-Group A Streptococcus: 100,000 to 250,000 units/kg/day IV in divided doses every 4 to 6 hours

Comments:
-PIDS/IDSA: Recommended as preferred parenteral therapy
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Endocarditis:

150,000 units/kg/day IV in equally divided doses every 4 to 6 hours
Duration of therapy: Depends on nature and severity of infection

Use: For the treatment of endocarditis due to susceptible strains of streptococci (including S pneumoniae) and meningococcus

AHA Recommendations:
1 year or older: 200,000 to 300,000 units/kg/day IV in divided doses every 4 hours
Maximum dose: 12 to 24 million units/day
Duration of therapy: At least 4 to 6 weeks

Comments:
-Recommended regimen for highly penicillin G-susceptible streptococci (minimum bactericidal concentration [MBC] up to 0.1 mcg/mL), relatively penicillin-resistant streptococci (MBC at least 0.2 mcg/mL), and staphylococci (S aureus or coagulase-negative staphylococci) susceptible to up to 1 mcg/mL penicillin G (rare)
-Streptococci highly susceptible to penicillin G include most viridans streptococci, groups A, B, C, G, nonenterococcal group D streptococci (S bovis, S equinus).
-Streptococci relatively resistant to penicillin include enterococci and less susceptible viridans streptococci; this drug should be used with gentamicin for at least the first 2 weeks.
-Pediatric dose should not exceed adult dose.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Meningitis -- Meningococcal:

250,000 units/kg/day IV in equally divided doses every 4 hours
Duration of therapy: 7 to 14 days, depending on nature and severity of infection
Maximum dose: 12 to 20 million units/day

AAP Recommendations: 300,000 units/kg/day IV in divided doses every 4 to 6 hours
Maximum dose: 12 million units/day

IDSA Recommendations:
-Neonates, age 0 to 7 days: 150,000 units/kg/day IV in divided doses every 8 to 12 hours
-Neonates, age 8 to 28 days: 200,000 units/kg/day IV in divided doses every 6 to 8 hours
-Infants and children: 300,000 units/kg/day IV in divided doses every 4 to 6 hours
Maximum dose: 24 million units/day

Comments:
-IDSA: Recommended as an alternative agent for infection due to N meningitidis; considered standard therapy for N meningitidis infection with penicillin MIC less than 0.1 mcg/mL; smaller doses and longer intervals may be appropriate for very low birthweight neonates (less than 2 kg).
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Meningitis:

250,000 units/kg/day IV in equally divided doses every 4 hours
Duration of therapy: 7 to 14 days, depending on nature and severity of infection
Maximum dose: 12 to 20 million units/day

Use: For the treatment of meningitis due to susceptible strains of pneumococcus

AAP Recommendations:
-Invasive pneumococcal infections in patients 1 month or older: 250,000 to 400,000 units/kg/day IV in divided doses every 4 to 6 hours

IDSA Recommendations:
-Neonates, age 0 to 7 days: 150,000 units/kg/day IV in divided doses every 8 to 12 hours
-Neonates, age 8 to 28 days: 200,000 units/kg/day IV in divided doses every 6 to 8 hours
-Infants and children: 300,000 units/kg/day IV in divided doses every 4 to 6 hours
Maximum dose: 24 million units/day

Duration of therapy:
-L monocytogenes: At least 21 days
-S agalactiae: 14 to 21 days
-S pneumoniae: 10 to 14 days

Comments:
-IDSA: A recommended agent for infection due to L monocytogenes or S agalactiae; considered standard therapy for S pneumoniae infection with penicillin MIC less than 0.1 mcg/mL; smaller doses and longer intervals may be appropriate for very low birthweight neonates (less than 2 kg).
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Meningitis -- Pneumococcal:

250,000 units/kg/day IV in equally divided doses every 4 hours
Duration of therapy: 7 to 14 days, depending on nature and severity of infection
Maximum dose: 12 to 20 million units/day

Use: For the treatment of meningitis due to susceptible strains of pneumococcus

AAP Recommendations:
-Invasive pneumococcal infections in patients 1 month or older: 250,000 to 400,000 units/kg/day IV in divided doses every 4 to 6 hours

IDSA Recommendations:
-Neonates, age 0 to 7 days: 150,000 units/kg/day IV in divided doses every 8 to 12 hours
-Neonates, age 8 to 28 days: 200,000 units/kg/day IV in divided doses every 6 to 8 hours
-Infants and children: 300,000 units/kg/day IV in divided doses every 4 to 6 hours
Maximum dose: 24 million units/day

Duration of therapy:
-L monocytogenes: At least 21 days
-S agalactiae: 14 to 21 days
-S pneumoniae: 10 to 14 days

Comments:
-IDSA: A recommended agent for infection due to L monocytogenes or S agalactiae; considered standard therapy for S pneumoniae infection with penicillin MIC less than 0.1 mcg/mL; smaller doses and longer intervals may be appropriate for very low birthweight neonates (less than 2 kg).
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Meningitis -- Streptococcus Group B:

AAP Recommendations:
-Infants 7 days or younger: 250,000 to 450,000 units/kg/day IV in 3 divided doses
-Infants older than 7 days: 450,000 to 500,000 units/kg/day IV in 4 divided doses
Duration of therapy (uncomplicated meningitis): 14 days

Comments:
-Longer duration of therapy may be needed for patients with prolonged or complicated infections.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Congenital Syphilis:

1 month or older: 200,000 to 300,000 units/kg/day, administered as 50,000 units/kg IV every 4 to 6 hours for 10 to 14 days

Use: For the treatment of congenital syphilis due to T pallidum

US CDC and AAP Recommendations:
Neonates: 100,000 to 150,000 units/kg/day, administered as 50,000 units/kg IV every 12 hours during the first 7 days of life and every 8 hours thereafter for 10 days total
1 month or older: 200,000 to 300,000 units/kg/day, administered as 50,000 units/kg IV every 4 to 6 hours for 10 days

Comments:
-Recommended as a preferred regimen for neonates with proven, highly probable, or possible congenital syphilis, for infants and children (1 month or older) who possibly have congenital syphilis or who have neurologic involvement, for children older than 2 years with late and previously untreated congenital syphilis
-US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society (PIDS), and AAP also recommend this regimen for HIV-exposed and HIV-infected children.
-In neonates, dose should be based on chronologic age.
-If more than 1 day of therapy is missed in neonates with proven or highly probable disease, the entire course should be repeated.
-Some experts recommend following this regimen with penicillin G benzathine.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Neurosyphilis:

1 month or older: 200,000 to 300,000 units/kg/day, administered as 50,000 units/kg IV every 4 to 6 hours for 10 to 14 days

Use: For the treatment of neurosyphilis due to T pallidum

AAP Recommendations for Patients Older than 1 Month and US CDC, NIH, HIVMA/IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children: 200,000 to 300,000 units/kg/day, administered as 50,000 units/kg IV every 4 to 6 hours for 10 to 14 days
Maximum dose: 18 to 24 million units/day

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Adolescents: 18 to 24 million units/day, administered as 3 to 4 million units IV every 4 hours or a continuous IV infusion for 10 to 14 days

Comments:
-Recommended as the preferred regimen for neurosyphilis in patients older than 1 month, for neurosyphilis (including ocular) in HIV-exposed and HIV-infected children, and for neurosyphilis, ocular syphilis, and otic syphilis in HIV-infected adolescents
-Duration of neurosyphilis therapy is shorter than the duration for latent syphilis therapy; penicillin G benzathine can be considered after completing this drug to provide comparable total duration of therapy.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Inhalation Bacillus anthracis:

AAP Recommendations:
Up to 4 weeks of age:
-Gestational age 32 to 34 weeks, up to 1 week of age: 200,000 units/kg/day IV in divided doses every 12 hours
-Gestational age 32 to 34 weeks, 1 to 4 weeks of age: 300,000 units/kg/day IV in divided doses every 8 hours
-Gestational age 34 to 37 weeks and term neonate, up to 1 week of age: 300,000 units/kg/day IV in divided doses every 8 hours
-Gestational age 34 to 37 weeks and term neonate, 1 to 4 weeks of age: 400,000 units/kg/day IV in divided doses every 6 hours

1 month or older: 400,000 units/kg/day IV in divided doses every 4 hours
Maximum dose: 4 million units/dose

Duration of therapy:
-Severe anthrax (up to 4 weeks of age): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-Systemic anthrax with possible/confirmed meningitis (1 month or older): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-Systemic anthrax when meningitis has been excluded (1 month or older): At least 14 days or until patient is clinically stable (whichever is longer)
-Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:
-Recommended as an alternative agent for the treatment of systemic/severe anthrax due to penicillin-susceptible strains
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal fluoroquinolone is recommended with possible/confirmed meningitis.
-Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Cutaneous Bacillus anthracis:

AAP Recommendations:
Up to 4 weeks of age:
-Gestational age 32 to 34 weeks, up to 1 week of age: 200,000 units/kg/day IV in divided doses every 12 hours
-Gestational age 32 to 34 weeks, 1 to 4 weeks of age: 300,000 units/kg/day IV in divided doses every 8 hours
-Gestational age 34 to 37 weeks and term neonate, up to 1 week of age: 300,000 units/kg/day IV in divided doses every 8 hours
-Gestational age 34 to 37 weeks and term neonate, 1 to 4 weeks of age: 400,000 units/kg/day IV in divided doses every 6 hours

1 month or older: 400,000 units/kg/day IV in divided doses every 4 hours
Maximum dose: 4 million units/dose

Duration of therapy:
-Severe anthrax (up to 4 weeks of age): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-Systemic anthrax with possible/confirmed meningitis (1 month or older): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-Systemic anthrax when meningitis has been excluded (1 month or older): At least 14 days or until patient is clinically stable (whichever is longer)
-Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:
-Recommended as an alternative agent for the treatment of systemic/severe anthrax due to penicillin-susceptible strains
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal fluoroquinolone is recommended with possible/confirmed meningitis.
-Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Diphtheria:

150,000 to 250,000 units/kg/day IV in equally divided doses every 6 hours for 7 to 10 days

Comments:
-AAP recommendations: As IV antimicrobial therapy for 14 days; not a substitute for primary therapy (antitoxin); current guidelines should be consulted for additional information.

Uses: For diphtheria (as adjunctive therapy to antitoxin and prevention of carrier state) due to C diphtheriae

Usual Pediatric Dose for Rat-bite Fever:

150,000 to 250,000 units/kg/day IV in equally divided doses every 4 hours for 4 weeks

Comments:
-AAP recommendations: As IV therapy for 5 days to at least 4 weeks; current guidelines should be consulted for additional information.

Uses: For the treatment of Haverhill fever with endocarditis due to S moniliformis; for the treatment of rat-bite fever due to S minus or S moniliformis

Usual Pediatric Dose for Lyme Disease -- Arthritis:

AAN, AAP, and IDSA Recommendations:
Children: 200,000 to 400,000 units/kg/day IV in divided doses every 4 hours
Maximum dose: 18 to 24 million units/day
Duration of therapy: 14 days

Comments:
-AAP recommends this drug as an alternative parenteral regimen for recurrent arthritis, carditis, meningitis, and encephalitis/other late neurologic disease (including peripheral neuropathy, encephalopathy).
-IDSA recommends this drug as an alternative parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lyme Disease -- Carditis:

AAN, AAP, and IDSA Recommendations:
Children: 200,000 to 400,000 units/kg/day IV in divided doses every 4 hours
Maximum dose: 18 to 24 million units/day
Duration of therapy: 14 days

Comments:
-AAP recommends this drug as an alternative parenteral regimen for recurrent arthritis, carditis, meningitis, and encephalitis/other late neurologic disease (including peripheral neuropathy, encephalopathy).
-IDSA recommends this drug as an alternative parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lyme Disease -- Neurologic:

AAN, AAP, and IDSA Recommendations:
Children: 200,000 to 400,000 units/kg/day IV in divided doses every 4 hours
Maximum dose: 18 to 24 million units/day
Duration of therapy: 14 days

Comments:
-AAP recommends this drug as an alternative parenteral regimen for recurrent arthritis, carditis, meningitis, and encephalitis/other late neurologic disease (including peripheral neuropathy, encephalopathy).
-IDSA recommends this drug as an alternative parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin or Soft Tissue Infection:

IDSA Recommendations:
1 month or older: 60,000 to 100,000 units/kg IV every 6 hours
Maximum dose: 2 to 4 million units/dose

Comments:
-Recommended for the treatment of non-purulent skin and soft tissue infection (cellulitis)/streptococcal skin infection
-In combination with clindamycin, recommended as the preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to Streptococcus or Clostridium species
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Tetanus:

AAP Recommendations: 100,000 units/kg/day IV in divided doses every 4 to 6 hours
Maximum dose: 12 million units/day
Duration of therapy: 7 to 10 days

Comments:
-Recommended as alternative therapy
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Gonococcal Infection -- Disseminated:

Less than 45 kg:
-Arthritis: 100,000 units/kg/day in 4 equally divided doses for 7 to 10 days
-Meningitis: 250,000 units/kg/day in equally divided doses every 4 hours for 10 to 14 days
-Endocarditis: 250,000 units/kg/day in equally divided doses every 4 hours for 4 weeks

At least 45 kg:
-Arthritis, meningitis, endocarditis: 10 million units/day in 4 equally divided doses
-Duration of therapy: Depends on the type of infection

Comments:
-Due to resistance, penicillins are not recommended by the US CDC.
-Current guidelines should be consulted for additional information.

Use: For the treatment of disseminated gonococcal infections (arthritis, meningitis, endocarditis) due to penicillin-susceptible N gonorrhoeae

What other drugs will affect penicillin G sodium?

Other drugs may interact with penicillin G sodium, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about penicillin G sodium.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.02. Revision Date: 2015-01-12, 3:32:59 PM.

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