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penicillin G sodium

Pronunciation

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?

You should not use this medication 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.

Before using penicillin G sodium, tell your doctor if you have asthma or a history of allergies, liver disease, kidney disease, or heart disease.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Penicillin G sodium will not treat a viral infection such as the common cold or flu.

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.

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

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

To make sure you can safely use penicillin G sodium, tell your doctor if you have any of these other conditions:

  • asthma or a history of allergies;

  • liver disease;

  • kidney disease; or

  • heart disease.

FDA pregnancy category B. This medication is not expected to be harmful to 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. Do not use this medication without telling 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 medication.

Prepare your dose in a syringe only when you are ready to give yourself an injection. Do not use the medication if it has changed colors or has particles in it. Call your doctor for a new prescription.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Penicillin G sodium will not treat a viral infection such as the common cold or flu.

If you use this medication 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. Visit your doctor regularly.

This medication 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 unmixed 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 an appointment for your penicillin G sodium injection.

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 any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

  • diarrhea that is watery or bloody;

  • blood in your urine;

  • feeling like you might pass out;

  • fever, chills, swollen glands, body aches, flu symptoms, rash or itching, muscle or joint pain, night sweats, general ill feeling;

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

  • urinating less than usual or not at all;

  • skin rash with bruising, severe tingling, numbness, pain, muscle weakness;

  • swelling in your hands or feet;

  • pale or yellowed skin, dark colored urine, fever, confusion or weakness;

  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • twitching or uncontrollable muscle movements; or

  • increased thirst, feeling restless, increased urination, muscle pain or weakness, irregular heart rate, weak pulse, tingly feeling, feeling light-headed, fainting, or seizure (convulsions).

Less serious side effects may include:

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

  • overactive reflexes;

  • nausea, vomiting; or

  • black or hairy tongue.

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 Streptococcal Infection:

Serious infections due to susceptible strains of streptococci (including Streptococcus pneumoniae): 5 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Such infections include septicemia, empyema, pneumonia, pericarditis, endocarditis, and meningitis.

Usual Adult Dose for Bacterial Infection:

Serious infections due to susceptible strains of streptococci (including S pneumoniae) or staphylococci: 5 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Such infections include septicemia, empyema, pneumonia, pericarditis, endocarditis, and meningitis.

Pasteurella infections (including bacteremia and meningitis): 4 million to 6 million units/day IV in divided doses every 4 to 6 hours for 2 weeks

Usual Adult Dose for Pneumonia:

Serious infections due to susceptible strains of streptococci or staphylococci: 5 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Usual Adult Dose for Septicemia:

Serious infections due to susceptible strains of streptococci or staphylococci: 5 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Usual Adult Dose for Endocarditis:

Serious infections due to susceptible strains of streptococci or staphylococci: 5 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Erysipelothrix rhusiopathiae: 12 million to 20 million units/day IV in divided doses every 4 to 6 hours for 4 to 6 weeks; 2 million to 20 million units/day has been recommended

Listeria monocytogenes: 15 million to 20 million units/day IV in divided doses every 4 to 6 hours for 4 weeks

American Heart Association (AHA) recommendations:
Patients with normal renal function:
Native valve infections due to highly penicillin-susceptible Streptococcus viridans or S bovis (MIC 0.12 mcg/mL or less): 12 million to 18 million units/day IV continuously or in 4 or 6 divided doses for 4 weeks; may add gentamicin 3 mg/kg/day IM or IV for 2 weeks

Native valve infections due to relatively resistant strains of S viridans or S bovis (MIC greater than 0.12 mcg/mL and up to 0.5 mcg/mL): 24 million units/day IV continuously or in 4 to 6 divided doses for 4 weeks plus gentamicin 3 mg/kg/day IV for 2 weeks

Prosthetic valve infections due to penicillin-susceptible S viridans or S bovis (MIC 0.12 mcg/mL or less): 24 million units/day IV continuously or in 4 to 6 divided doses for 6 weeks with or without gentamicin 3 mg/kg/day IV for 2 weeks

Prosthetic valve infections due to relatively or fully resistant S viridans or S bovis (MIC greater than 0.12 mcg/mL): 24 million units/day IV continuously or in 4 to 6 divided doses for 6 weeks plus gentamicin 3 mg/kg/day IV for 6 weeks

Native valve or prosthetic valve infections due to susceptible enterococci: 18 million to 30 million units/day IV continuously or in 6 divided doses plus gentamicin 3 mg/kg/day IM or IV or streptomycin 7.5 mg/kg IV or IM (if gentamicin resistant) every 12 hours for 4 to 6 weeks

Usual Adult Dose for Meningitis:

Serious infections due to susceptible strains of streptococci or staphylococci: 5 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Listerial meningitis: 15 million to 20 million units/day IV in divided doses every 4 to 6 hours for 2 weeks

Pasteurella meningitis: 4 million to 6 million units/day IV in divided doses every 4 to 6 hours for 2 weeks

Usual Adult Dose for Meningitis -- Meningococcal:

Meningococcal meningitis and/or septicemia: 1 million to 2 million units IM every 2 hours or 20 million to 30 million units/day as a continuous IV infusion for at least 10 to 14 days

If meningococcal meningitis is suspected, immediate treatment with penicillin is required, and should be started before lumbar puncture confirmation of the diagnosis. The mortality of this disease is 50% within the first 24 hours.

Usual Adult Dose for Meningitis -- Pneumococcal:

Serious infections due to susceptible strains: 5 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Usual Adult Dose for Neurosyphilis:

Manufacturer recommendation: 2 million to 4 million units IV every 4 hours for 10 to 14 days

Centers for Disease Control and Prevention (CDC) recommendation: 3 million to 4 million units IV every 4 hours or 18 million to 24 million units/day as a continuous infusion for 10 to 14 days

Many experts recommend additional therapy with penicillin G benzathine 2.4 million units IM once a week for up to 3 weeks following completion of IV therapy.

Usual Adult Dose for Actinomycosis:

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

Duration: Prolonged therapy (1.5 to 18 months or longer) may be necessary. Four to 6 weeks followed by oral therapy for 6 to 12 months, depending on the nature and severity of the infection, has been recommended for patients with pulmonary actinomycosis or other severe infections caused by the organism.

Usual Adult Dose for Inhalation Bacillus anthracis:

Treatment of penicillin-susceptible anthrax:
As the result of naturally occurring or endemic anthrax exposure: Minimum of 8 million units/day IV in divided doses every 6 hours; higher doses may be needed depending on susceptibility of organism

Dosages up to 20 million units/day IV have been used to treat anthrax septicemia and intestinal, pulmonary, and meningeal anthrax. Some clinicians recommend 8 million to 12 million units/day in divided doses every 4 to 6 hours for the treatment of anthrax due to natural or endemic anthrax exposures.

Duration: At least 14 days after symptoms abate

As the result of exposure to B anthracis spores during biologic warfare or bioterrorism: 4 million units IV every 4 hours; oral therapy may be substituted once the patient's clinical condition improves

Treatment of inhalation anthrax should be started with a multiple-drug parenteral regimen that includes ciprofloxacin or doxycycline plus 1 or 2 additional antibiotics with activity against the causative organism. A multiple-drug parenteral regimen is also recommended for initial treatment of cutaneous anthrax if there are signs of systemic involvement, extensive edema, or lesions on the head or neck. Due to concerns regarding resistance, penicillin alone is not recommended for inhalation anthrax that occurs as the result of biologic warfare or bioterrorism since high concentrations of the organism are expected, but it can be included in appropriate combination therapies.

Duration: 60 days (including IV and oral therapy)

Usual Adult Dose for Cutaneous Bacillus anthracis:

Treatment of penicillin-susceptible anthrax:
As the result of naturally occurring or endemic anthrax exposure: Minimum of 8 million units/day IV in divided doses every 6 hours; higher doses may be needed depending on susceptibility of organism

Dosages up to 20 million units/day IV have been used to treat anthrax septicemia and intestinal, pulmonary, and meningeal anthrax. Some clinicians recommend 8 million to 12 million units/day in divided doses every 4 to 6 hours for the treatment of anthrax due to natural or endemic anthrax exposures.

Duration: At least 14 days after symptoms abate

As the result of exposure to B anthracis spores during biologic warfare or bioterrorism: 4 million units IV every 4 hours; oral therapy may be substituted once the patient's clinical condition improves

Treatment of inhalation anthrax should be started with a multiple-drug parenteral regimen that includes ciprofloxacin or doxycycline plus 1 or 2 additional antibiotics with activity against the causative organism. A multiple-drug parenteral regimen is also recommended for initial treatment of cutaneous anthrax if there are signs of systemic involvement, extensive edema, or lesions on the head or neck. Due to concerns regarding resistance, penicillin alone is not recommended for inhalation anthrax that occurs as the result of biologic warfare or bioterrorism since high concentrations of the organism are expected, but it can be included in appropriate combination therapies.

Duration: 60 days (including IV and oral therapy)

Usual Adult Dose for Botulism:

Adjunctive therapy to antitoxin: 20 million units/day IV in divided doses every 4 to 6 hours

Wound botulism (as an adjunct to antitoxin, supportive care, and surgical debridement): 2 million units IV every 4 hours plus metronidazole 250 mg IV every 6 hours

Usual Adult Dose for Tetanus:

Adjunctive therapy to human tetanus immune globulin: 20 million units/day in divided doses every 4 to 6 hours

Usual Adult Dose for Clostridial Infection:

Gas gangrene (debridement and/or surgery as indicated): 20 million units/day in divided doses every 4 to 6 hours

Usual Adult Dose for Diphtheria:

As an adjunct to antitoxin and to prevent carrier state: 2 million to 3 million units/day IV in divided doses every 4 to 6 hours for 10 to 12 days

To eliminate carrier state: 300,000 to 400,000 units/day IM in divided doses for 10 to 12 days

Usual Adult Dose for Fusospirochetosis:

Severe infections of the oropharynx (Vincent's), lower respiratory tract, and genital area: 5 million to 10 million units/day IV in divided doses every 4 to 6 hours

Usual Adult Dose for Bacteremia:

Pasteurella bacteremia: 4 million to 6 million units/day IV in divided doses every 4 to 6 hours for 2 weeks

Usual Adult Dose for Rat-bite Fever:

Infections due to Streptobacillus moniliformis (rat-bite fever or Haverhill fever) or Spirillum minus (rat-bite fever): 12 million to 20 million units/day IV in divided doses every 4 to 6 hours for 3 to 4 weeks

Usual Adult Dose for Lyme Disease -- Neurologic:

Early Lyme disease with acute neurologic disease manifested by meningitis or radiculopathy: 18 million to 24 million units/day IV in divided doses every 4 hours

Late Lyme disease and associated neurologic disease affecting the CNS or peripheral nerve disease (e.g., neuropathy, encephalopathy) and documented by CSF analysis: 18 million to 24 million units/day IV in divided doses every 4 to 6 hours

Duration: 14 to 28 days

Penicillin G is recommended as an alternative to IV ceftriaxone. Ceftriaxone is considered the parenteral drug of choice.

Usual Adult Dose for Lyme Disease -- Carditis:

Third-degree atrioventricular (AV) heart block or a PR interval exceeding 0.3 seconds: 18 million to 24 million units/day IV in divided doses every 4 to 6 hours, with cardiac monitoring and a temporary pacemaker for complete heart block

Duration: 14 to 21 days

Penicillin G is recommended as an alternative to IV ceftriaxone. Ceftriaxone is considered the parenteral drug of choice.

Usual Adult Dose for Lyme Disease -- Arthritis:

Recurrent arthritis after oral treatment: 18 million to 24 million units/day IV in divided doses every 4 hours for 14 to 28 days

Penicillin G is recommended as an alternative to IV ceftriaxone for patients with late Lyme disease who have arthritis and objective proof of neurologic disease. It is also recommended as an alternative for patients with persistent or recurrent arthritis after oral treatment; IV therapy is only recommended in those patients whose arthritis showed no improvement or worsened. Ceftriaxone is considered the parenteral drug of choice.

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

5 million units IV at onset of labor or after membrane rupture followed by 2.5 million to 3 million units IV every 4 hours until delivery

Usual Adult Dose for Leptospirosis:

1.5 million units IV every 6 hours for 7 days

Usual Adult Dose for Deep Neck Infection:

2 million to 4 million units IV or IM every 4 to 6 hours for 2 to 3 weeks, depending on the nature and severity of the infection

The addition of metronidazole to high-dose penicillin therapy is recommended by many experts to treat parapharyngeal infections because of the increasing frequency of penicillin-resistant anaerobes. Removal of abscessed material is also necessary for successful treatment.

Usual Adult Dose for Skin or Soft Tissue Infection:

Erysipelas: 1 million to 2 million units IV every 4 to 6 hours
Streptococcal cellulitis: 1 million to 2 million units IV every 6 hours for 7 to 10 days

Usual Adult Dose for Aspiration Pneumonia:

2 million to 3 million units IV every 4 to 6 hours plus metronidazole 500 mg IV every 8 hours for 7 to 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Joint Infection:

2 million to 3 million units IV every 4 hours for 2 weeks, depending on the nature and severity of the infection

Usual Adult Dose for Gonococcal Infection -- Disseminated:

Infections (such as meningitis, endocarditis, arthritis, etc.) caused by penicillin-susceptible organisms: 10 million units/day IV in divided doses every 4 to 6 hours

Duration: Depends on the nature and severity of the infection

Due to resistance, penicillin G is not recommended by the CDC. Ceftriaxone is the drug of choice.

Usual Adult Dose for Gram Negative Infection:

Gram-negative bacillary bacteremia (Escherichia coli, Enterobacter aerogenes, Alcaligenes faecalis, Salmonella, Shigella, and Proteus mirabilis): 20 million to 80 million units per day

Penicillin G is not the drug of choice in the treatment of gram-negative bacillary infections. Other more effective anti-infectives are usually used for the treatment of these infections.

Usual Pediatric Dose for Bacterial Infection:

American Academy of Pediatrics (AAP) recommendations:
Neonates:
7 days or less:
2000 g or less: 25,000 to 50,000 units/kg IM or IV every 12 hours
Greater than 2000 g: 25,000 to 50,000 units/kg IM or IV every 8 hours

Greater than 7 days:
Less than 1200 g: 25,000 to 50,000 units/kg IM or IV every 12 hours
1200 to 2000 g: 25,000 to 50,000 units/kg IM or IV every 8 hours
Greater than 2000 g: 25,000 to 50,000 units/kg IM or IV every 6 hours

Infants and children:
Mild to moderate infections: 100,000 to 250,000 units/kg/day IM or IV in divided doses every 4 to 6 hours
Severe infections: 250,000 to 400,000 units/kg/day IM or IV in 4 to 6 divided doses

Maximum dose: 24 million units/day

Usual Pediatric Dose for Pneumonia:

Manufacturer recommendation:
Serious infections, such as pneumonia and endocarditis, due to susceptible strains of streptococci (including S pneumoniae) and meningococcus: 150,000 units/kg/day IV in divided doses every 4 to 6 hours

The duration of therapy depends on the nature and severity of the infection.

Usual Pediatric Dose for Streptococcal Infection:

Manufacturer recommendation:
Serious infections, such as pneumonia and endocarditis, due to susceptible strains of streptococci (including S pneumoniae) and meningococcus: 150,000 units/kg/day IV in divided doses every 4 to 6 hours

The duration of therapy depends on the nature and severity of the infection.

Usual Pediatric Dose for Endocarditis:

Manufacturer recommendation:
Serious infections due to susceptible strains of streptococci and meningococcus: 150,000 units/kg/day IV in divided doses every 4 to 6 hours

The duration of therapy depends on the nature and severity of the infection.

AHA recommendations:
Patients with normal renal function (dosage should not exceed adult dose):
Native valve infections due to highly penicillin-susceptible Streptococcus viridans or S bovis (MIC 0.12 mcg/mL or less): Aqueous penicillin G sodium 200,000 units/kg/day (maximum: 18 million units/day) IV in 4 to 6 divided doses for 4 weeks; may add gentamicin 1 mg/kg IM or IV every 8 hours or 3 mg/kg IV every 24 hours for 2 weeks

Native valve infections due to relatively resistant strains of S viridans or S bovis (MIC greater than 0.12 mcg/mL and up to 0.5 mcg/mL): Aqueous penicillin G sodium 300,000 units/kg/day (maximum: 24 million units/day) IV in 4 to 6 divided doses for 4 weeks plus gentamicin 1 mg/kg IM or IV every 8 hours or 3 mg/kg IV every 24 hours for 2 weeks

Prosthetic valve infections due to penicillin-susceptible S viridans or S bovis (MIC 0.12 mcg/mL or less): Aqueous penicillin G sodium 300,000 units/kg/day (maximum: 24 million units/day) IV in 4 to 6 divided doses for 6 weeks with or without gentamicin 1 mg/kg IM or IV every 8 hours or 3 mg/kg IV every 24 hours for 2 weeks

Prosthetic valve infections due to relatively or fully resistant S viridans or S bovis (MIC greater than 0.12 mcg/mL): Aqueous penicillin G sodium 300,000 units/kg/day (maximum: 24 million units/day) IV in 4 to 6 divided doses for 6 weeks plus gentamicin 1 mg/kg IM or IV every 8 hours for 6 weeks

Native valve or prosthetic valve infections due to susceptible enterococci: Aqueous penicillin G sodium 300,000 units/kg/day (maximum: 30 million units/day) IV in 4 to 6 divided doses, plus gentamicin 1 mg/kg IM or IV every 8 hours or streptomycin 10 to 15 mg/kg IV or IM (if gentamicin resistant) every 12 hours for 4 to 6 weeks

Usual Pediatric Dose for Meningitis -- Meningococcal:

Manufacturer recommendation: 250,000 units/kg/day IV in divided doses every 4 hours for 7 to 14 days, depending on the nature and severity of the infection

Maximum dose: 12 million to 20 million units/day

Usual Pediatric Dose for Meningitis -- Pneumococcal:

Manufacturer recommendation: 250,000 units/kg/day IV in divided doses every 4 hours for 7 to 14 days, depending on the nature and severity of the infection

Maximum dose: 12 million to 20 million units/day

AAP recommendation:
1 month or older: 250,000 to 400,000 units/kg/day IV in 4 to 6 divided doses

Usual Pediatric Dose for Meningitis -- Streptococcus Group B:

AAP recommendation:
Neonates 7 days or younger: 250,000 to 450,000 units/kg/day IV in 3 divided doses
Neonates older than 7 days: 450,000 units/kg/day IV in 4 divided doses

Usual Pediatric Dose for Congenital Syphilis:

Less than 1 month (symptomatic neonates and neonates with proven or presumed congenital syphilis): 50,000 units/kg IV every 12 hours during the first 7 days of life and every 8 hours thereafter for 10 days total; if more than 1 day of therapy is missed in patients with proven or highly probable disease, the entire course should be repeated

1 month or older: 50,000 units/kg IV every 4 to 6 hours for 10 days; some clinicians recommend following this regimen with penicillin G benzathine 50,000 units/kg IM once a week for 1 to 3 weeks

Usual Pediatric Dose for Neurosyphilis:

Manufacturer recommendation:
1 month or older: 50,000 units/kg IV every 4 to 6 hours for 10 to 14 days

CDC recommendation:
Adolescents: 3 million to 4 million units IV every 4 hours or 18 million to 24 million units/day as a continuous infusion for 10 to 14 days; many experts recommend additional therapy with penicillin G benzathine 2.4 million units IM once a week for up to 3 weeks following completion of IV therapy

Usual Pediatric Dose for Inhalation Bacillus anthracis:

Treatment of penicillin-susceptible anthrax:
As the result of naturally occurring or endemic anthrax exposure:
Children: Some clinicians recommend 100,000 to 150,000 units/kg/day in divided doses every 4 to 6 hours.

Duration: At least 14 days after symptoms abate

As the result of exposure to B anthracis spores during biologic warfare or bioterrorism:
Children less than 12 years: 50,000 units/kg IV every 6 hours; oral therapy may be substituted once the patient's clinical condition improves

Treatment of inhalation anthrax should be started with a multiple-drug parenteral regimen that includes ciprofloxacin or doxycycline plus 1 or 2 additional antibiotics with activity against the causative organism. A multiple-drug parenteral regimen is also recommended for initial treatment of cutaneous anthrax if there are signs of systemic involvement, extensive edema, or lesions on the head or neck. Due to concerns regarding resistance, penicillin alone is not recommended for inhalation anthrax that occurs as the result of biologic warfare or bioterrorism since high concentrations of the organism are expected, but it can be included in appropriate combination therapies.

Duration: 60 days (including IV and oral therapy)

Usual Pediatric Dose for Cutaneous Bacillus anthracis:

Treatment of penicillin-susceptible anthrax:
As the result of naturally occurring or endemic anthrax exposure:
Children: Some clinicians recommend 100,000 to 150,000 units/kg/day in divided doses every 4 to 6 hours.

Duration: At least 14 days after symptoms abate

As the result of exposure to B anthracis spores during biologic warfare or bioterrorism:
Children less than 12 years: 50,000 units/kg IV every 6 hours; oral therapy may be substituted once the patient's clinical condition improves

Treatment of inhalation anthrax should be started with a multiple-drug parenteral regimen that includes ciprofloxacin or doxycycline plus 1 or 2 additional antibiotics with activity against the causative organism. A multiple-drug parenteral regimen is also recommended for initial treatment of cutaneous anthrax if there are signs of systemic involvement, extensive edema, or lesions on the head or neck. Due to concerns regarding resistance, penicillin alone is not recommended for inhalation anthrax that occurs as the result of biologic warfare or bioterrorism since high concentrations of the organism are expected, but it can be included in appropriate combination therapies.

Duration: 60 days (including IV and oral therapy)

Usual Pediatric Dose for Diphtheria:

Manufacturer recommendation:
As an adjunct to antitoxin and to prevent carrier state: 150,000 to 250,000 units/kg/day IV in divided doses every 6 hours for 7 to 10 days

AAP recommendation:
As an adjunct to antitoxin: 100,000 to 150,000 units/kg/day IV in 4 divided doses for 14 days

Usual Pediatric Dose for Rat-bite Fever:

Infections due to S moniliformis (rat-bite fever or Haverhill fever [with endocarditis]) or S minus (rat-bite fever): 150,000 to 250,000 units/kg/day in divided doses every 4 hours for 4 weeks

Usual Pediatric Dose for Lyme Disease -- Neurologic:

Children: 200,000 to 400,000 units/kg/day IV in divided doses every 4 to 6 hours for 14 to 28 days
Maximum dose: 18 million to 24 million units/day

Penicillin G is recommended as an alternative to IV ceftriaxone or IV cefotaxime for patients with early Lyme disease who have acute neurologic disease manifested by meningitis or radiculopathy. It is also recommended as an alternative for patients with late Lyme disease and associated neurologic disease affecting the CNS or peripheral nerve disease (e.g., neuropathy, encephalopathy) and documented by CSF analysis. Ceftriaxone is considered the parenteral drug of choice.

Usual Pediatric Dose for Lyme Disease -- Carditis:

Third-degree AV heart block or a PR interval exceeding 0.3 seconds during early Lyme disease:
Children: 200,000 to 400,000 units/kg/day IV in divided doses every 4 to 6 hours for 14 to 21 days
Maximum dose: 18 million to 24 million units/day

Ceftriaxone is considered the parenteral drug of choice.

Usual Pediatric Dose for Lyme Disease -- Arthritis:

Children: 200,000 to 400,000 units/kg/day IV in divided doses every 4 hours for 14 to 28 days
Maximum dose: 18 million to 24 million units/day

Penicillin G is recommended as an alternative to IV ceftriaxone or IV cefotaxime for patients with late Lyme disease who have arthritis and objective proof of neurologic disease. It is also recommended as an alternative for patients with persistent or recurrent arthritis after oral treatment; IV therapy is only recommended in those patients whose arthritis showed no improvement or worsened. Ceftriaxone is considered the parenteral drug of choice.

Usual Pediatric Dose for Gonococcal Infection -- Disseminated:

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

45 kg or more:
Arthritis, meningitis, endocarditis: 10 million units/day in 4 divided doses; duration depends on the type of infection

Due to resistance, penicillin G is not recommended by the CDC. Ceftriaxone is the drug of choice.

What other drugs will affect penicillin G sodium?

Tell your doctor about all other medications you use, especially:

  • aspirin or indomethacin (Indocin);

  • birth control pills;

  • methotrexate (Rheumatrexate, Trexall);

  • probenecid (Benemid);

  • an antibiotic such as chloramphenicol (Chloromycetin) or erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin);

  • a diuretic (water pill) such as furosemide (Lasix) or ethacrynic acid (Edecrin);

  • sulfa drugs (Bactrim, Septra, Sulfatrim, SMX-TMP, and others); or

  • a tetracycline antibiotic, such as doxycycline (Doryx, Oracea, Periostat, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

This list is not complete and other drugs may interact with penicillin G sodium. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

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: 1.01. Revision Date: 2011-01-24, 9:57:54 AM.

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