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Penicillin G Benzathine / Procaine Penicillin Dosage

Applies to the following strength(s): 600,000 units-600,000 units/2 mL ; 300,000 units-300,000 units/mL ; 1,200,000 units-1,200,000 units/4 mL ; 900,000 units-300,000 units/2 mL ; 150,000 units-150,000 units/mL

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Skin or Soft Tissue Infection

Moderately severe to severe infections due to susceptible group A streptococci: 2,400,000 units IM once

Alternatively, one-half the total dose may be given on days 1 and 3. This regimen should be used only when the patient's cooperation can be assured.

Usual Adult Dose for Upper Respiratory Tract Infection

Moderately severe to severe infections due to susceptible group A streptococci: 2,400,000 units IM once

Alternatively, one-half the total dose may be given on days 1 and 3. This regimen should be used only when the patient's cooperation can be assured.

Usual Adult Dose for Streptococcal Infection

Erysipelas, scarlet fever:
Moderately severe to severe infections due to susceptible group A streptococci: 2,400,000 units IM once

Alternatively, one-half the total dose may be given on days 1 and 3. This regimen should be used only when the patient's cooperation can be assured.

Usual Adult Dose for Otitis Media

Moderately severe infections due to susceptible pneumococci: 1,200,000 units IM repeated every 2 to 3 days until temperature is normal for 48 hours

Other forms of penicillin may be required for severe cases.

Usual Adult Dose for Pneumonia

Moderately severe infections due to susceptible pneumococci: 1,200,000 units IM repeated every 2 to 3 days until temperature is normal for 48 hours

Other forms of penicillin may be required for severe cases.

Usual Pediatric Dose for Skin or Soft Tissue Infection

Moderately severe to severe infections due to susceptible group A streptococci:
Less than 14 kg: 600,000 units IM once
14 to less than 27 kg: 900,000 to 1,200,000 units IM once
27 kg or more: 2,400,000 units IM once

Alternatively, one-half the total dose may be given on days 1 and 3. This regimen should be used only when the patient's cooperation can be assured.

Usual Pediatric Dose for Upper Respiratory Tract Infection

Moderately severe to severe infections due to susceptible group A streptococci:
Less than 14 kg: 600,000 units IM once
14 to less than 27 kg: 900,000 to 1,200,000 units IM once
27 kg or more: 2,400,000 units IM once

Alternatively, one-half the total dose may be given on days 1 and 3. This regimen should be used only when the patient's cooperation can be assured.

Usual Pediatric Dose for Streptococcal Infection

Scarlet fever, erysipelas:
Moderately severe to severe infections due to susceptible group A streptococci:
Less than 14 kg: 600,000 units IM once
14 to less than 27 kg: 900,000 to 1,200,000 units IM once
27 kg or more: 2,400,000 units IM once

Alternatively, one-half the total dose may be given on days 1 and 3. This regimen should be used only when the patient's cooperation can be assured.

Usual Pediatric Dose for Otitis Media

Moderately severe infections due to susceptible pneumococci: 600,000 units IM repeated every 2 to 3 days until temperature is normal for 48 hours

Other forms of penicillin may be required for severe cases.

Usual Pediatric Dose for Pneumonia

Moderately severe infections due to susceptible pneumococci: 600,000 units IM repeated every 2 to 3 days until temperature is normal for 48 hours

Other forms of penicillin may be required for severe cases.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Benzathine penicillin-procaine penicillin is for deep intramuscular injection only. Inadvertent intravenous administration of penicillin G benzathine has resulted in cardiorespiratory arrest and fatalities. Injection of any penicillin into or near an artery or a nerve is contraindicated due to the risk of severe neurovascular damage. Intravascular administration has also resulted in immediate pallor, mottling, or cyanosis of the extremity followed by bleb formation, and severe edema requiring anterior and/or exterior compartment fasciotomy in lower extremities, especially in infants and small children.

IV penicillin G is preferable to IM administration in neonates since sterile abscesses and procaine toxicity occur more frequently with this age group than older patients.

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with adrenaline and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support, and airway management as clinically indicated.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following penicillin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Some patients may have procaine sensitivity. Procaine penicillin preparations should not be used in such patients.

Periodic monitoring of renal, hepatic, and hematologic function is recommended during high-dose or prolonged therapy.

The risk of adverse effects may be elevated in patients with impaired renal function and elderly patients are more likely to have renal insufficiency. In general, dose selection for elderly patients should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased renal, hepatic, or cardiac function, and of concomitant disease or other drug therapy. It may be useful to monitor renal function in elderly patients.

Superinfection with nonsusceptible organisms may occur with the use of antibiotics. Constant observation of the patient is essential. If new infections due to bacteria or fungi appear during treatment, the drug should be discontinued and appropriate measures taken.

Due to low plasma levels, benzathine penicillin-procaine penicillin should not be used for severe infections during the acute stage where high sustained penicillin plasma concentrations are required; intramuscular or intravenous penicillin G sodium or potassium should be used instead.

Benzathine penicillin-procaine penicillin should not be used in the treatment of venereal diseases, including syphilis, gonorrhea, yaws, bejel, and pinta, because subtherapeutic serum concentrations and treatment failure may occur.

In patients with streptococcal infections, clinicians should take measure to ascertain that therapy is sufficient to eradicate the organism and to prevent streptococcal sequelae.

To reduce the risk of development of drug-resistant organisms, antibiotics should only be used to treat or prevent proven or suspected infections caused by bacteria. Culture and susceptibility information should be considered when selecting treatment or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.

Dialysis

Data not available

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