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Penicillin G Potassium Dosage

Applies to the following strength(s): 5,000,000 units ; 20,000,000 units ; 1000000 units/50 mL ; 2000000 units/50 mL ; 3000000 units/50 mL ; 2,500,000 units/50 mL-NaCl 0.9%

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

Usual Adult Dose for Streptococcal Infection

Serious infections due to susceptible strains of streptococci (including Streptococcus pneumoniae): 12 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 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: 12 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Serious infections due to susceptible strains of 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: 12 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Serious infections due to susceptible strains of 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: 12 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Serious infections due to susceptible strains of 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: 2 million to 20 million units/day IV in divided doses every 4 to 6 hours for 4 to 6 weeks

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

Usual Adult Dose for Meningitis

Serious infections due to susceptible strains of streptococci: 12 million to 24 million units/day IV in divided doses every 4 to 6 hours, depending on the nature and severity of the infection

Serious infections due to susceptible strains of 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: 12 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

Manufacturers 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 Endocarditis

Manufacturers recommendation:
Serious infections, such as pneumonia and endocarditis, due to susceptible strains of streptococci (including S pneumoniae) and meningococcus: 150,000 to 300,000 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 Pneumonia

Manufacturers recommendation:
Serious infections, such as pneumonia and endocarditis, due to susceptible strains of streptococci (including S pneumoniae) and meningococcus: 150,000 to 300,000 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

Manufacturers recommendation:
Serious infections, such as pneumonia and endocarditis, due to susceptible strains of streptococci (including S pneumoniae) and meningococcus: 150,000 to 300,000 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 Meningitis - Meningococcal

Manufacturers 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

Manufacturers 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

Manufacturers 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

Manufacturers 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.

Renal Dose Adjustments

Adults:
Uremic patients with CrCl greater than 10 mL/min: Administer a full loading dose followed by one-half of the loading dose every 4 to 5 hours.

CrCl less than 10 mL/min: Administer a full loading dose followed by one-half of the loading dose every 8 to 10 hours.

Severe renal failure: Some clinicians recommend a maximum dosage of 4 million to 10 million units/day.

Additional dosage reductions are recommended in patients with hepatic disease and renal impairment.

Neonates: Because incompletely developed renal function in neonates may delay the elimination of penicillin, appropriate reduction in dosage and frequency of administration are recommended.

Liver Dose Adjustments

No adjustment required in patients with only hepatic impairment; however, dose reductions are recommended in patients with hepatic and renal impairment.

Precautions

Serious and occasionally fatal hypersensitivity (anaphylactoid) 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 epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Caution is recommended in patients with histories of significant allergies and/or asthma.

Solutions containing dextrose may be contraindicated in patients allergic to corn or corn products.

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.

High doses of intravenous penicillin G potassium (greater than 10 million units) should be administered slowly because electrolyte imbalances may occur due to its potassium content. The 20-million unit dosage of penicillin G potassium should only be administered by intravenous infusion. Penicillin G potassium contains 0.3 mEq sodium and 1.68 mEq potassium per million units and should be used with caution in patients with highly electrolyte-sensitive conditions.

Serum potassium should be monitored and corrective measures should be implemented when necessary.

Periodic monitoring of organ system function, including frequent evaluation of electrolyte balance, hepatic, renal, and hematopoietic systems, and cardiac and vascular status is recommended during prolonged treatment with high doses of intravenous penicillin G. The risk of neutropenia and serum sickness-like reactions may be increased during high-dose or prolonged therapy. A reduction in total dosage should be considered if any impairment of function occurs or is suspected.

Intravenous or inadvertent intraarterial administration or injection into or near major peripheral nerves or blood vessels should be avoided during intramuscular therapy as such injections may cause neurovascular damage.

If penicillin is used to treat gonococcal infections and syphilis is suspected, clinical and serologic testing should be performed before treatment and monthly for at least 4 months. If penicillin is used to treat syphilis, all patients should undergo clinical and serological testing every 6 months for 2 to 3 years.

Use of antibiotics may result in overgrowth of nonsusceptible organisms, including fungi. Indwelling intravenous catheters promote superinfections. Appropriate measures should be taken if superinfection occurs.

In patients with streptococcal infections, clinicians should take measure to ascertain that therapy is sufficient to eradicate the organism (at least 10 days) 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. Ambulatory patients should be advised to avoid missing doses and to complete the entire course of therapy.

Because incompletely developed renal function in neonates may delay the elimination of penicillin, appropriate reduction in dosage and frequency of administration are recommended. All neonates treated with penicillins should be monitored closely for clinical and laboratory signs of toxicity.

Dialysis

Data not available; however, hemodialysis has been shown to reduce penicillin G serum levels

Some clinicians recommend a maximum dosage of 4 million to 10 million units/day in patients with severe renal failure.

Other Comments

Penicillin G potassium may be given IM or by continuous IV infusion for dosages of 5 million units or less. The 20 million unit dosage should be administered via IV infusion only.

Due to its short half-life, penicillin G is given in divided doses, usually every 4 to 6 hours; however, it should be given every 2 hours when used for meningococcal meningitis/septicemia.

Treatment for most acute infections should be continued for at least 48 to 72 hours after the patient becomes asymptomatic. Treatment for group A beta-hemolytic streptococcal infections should be continued for at least 10 days to reduce the risk of rheumatic fever.

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