Procaine Penicillin Dosage
Applies to the following strengths: 1,200,000 units/2 mL; 600,000 units/mL; 2,400,000 units/4 mL
Usual Adult Dose for:
- Skin or Soft Tissue Infection
- Upper Respiratory Tract Infection
- Tonsillitis/Pharyngitis
- Streptococcal Infection
- Endocarditis
- Fusospirochetosis
- Pneumonia
- Bacterial Infection
- Cutaneous Bacillus anthracis
- Rat-bite Fever
- Anthrax Prophylaxis
- Neurosyphilis
- Tertiary Syphilis
- Syphilis - Latent
- Syphilis - Early
- Bejel
- Yaws
- Pinta
- Diphtheria
Usual Pediatric Dose for:
- Pneumonia
- Skin or Soft Tissue Infection
- Upper Respiratory Tract Infection
- Bacterial Infection
- Streptococcal Infection
- Anthrax Prophylaxis
- Congenital Syphilis
- Syphilis - Early
- Syphilis - Latent
- Neurosyphilis
- Diphtheria
Additional dosage information:
Usual Adult Dose for Skin or Soft Tissue Infection
600,000 to 1,000,000 units/day IM for at least 10 days
Uses: Moderately severe to severe group A streptococcal infections (tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue)/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
Usual Adult Dose for Upper Respiratory Tract Infection
600,000 to 1,000,000 units/day IM for at least 10 days
Uses: Moderately severe to severe group A streptococcal infections (tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue)/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
Usual Adult Dose for Tonsillitis/Pharyngitis
600,000 to 1,000,000 units/day IM for at least 10 days
Uses: Moderately severe to severe group A streptococcal infections (tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue)/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
Usual Adult Dose for Streptococcal Infection
600,000 to 1,000,000 units/day IM for at least 10 days
Uses: Moderately severe to severe group A streptococcal infections (tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue)/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
Usual Adult Dose for Endocarditis
600,000 to 1,000,000 units/day IM
Uses:
- Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
- Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
- Cutaneous anthrax due to Bacillus anthracis
- Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
- Erysipeloid due to Erysipelothrix rhusiopathiae
- Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms
Usual Adult Dose for Fusospirochetosis
600,000 to 1,000,000 units/day IM
Uses:
- Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
- Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
- Cutaneous anthrax due to Bacillus anthracis
- Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
- Erysipeloid due to Erysipelothrix rhusiopathiae
- Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms
Usual Adult Dose for Pneumonia
600,000 to 1,000,000 units/day IM
Uses:
- Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
- Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
- Cutaneous anthrax due to Bacillus anthracis
- Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
- Erysipeloid due to Erysipelothrix rhusiopathiae
- Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms
Usual Adult Dose for Bacterial Infection
600,000 to 1,000,000 units/day IM
Uses:
- Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
- Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
- Cutaneous anthrax due to Bacillus anthracis
- Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
- Erysipeloid due to Erysipelothrix rhusiopathiae
- Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms
Usual Adult Dose for Cutaneous Bacillus anthracis
600,000 to 1,000,000 units/day IM
Uses:
- Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
- Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
- Cutaneous anthrax due to Bacillus anthracis
- Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
- Erysipeloid due to Erysipelothrix rhusiopathiae
- Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms
Usual Adult Dose for Rat-bite Fever
600,000 to 1,000,000 units/day IM
Uses:
- Moderately severe (uncomplicated) pneumococcal pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Moderately severe to severe staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
- Subacute bacterial endocarditis (only in extremely sensitive infections) due to susceptible group A streptococci
- Cutaneous anthrax due to Bacillus anthracis
- Vincent's infection (fusospirochetosis)/moderately severe infections of the oropharynx due to susceptible fusiform bacilli and spirochetes (fusospirochetosis [Vincent's gingivitis and pharyngitis])
- Erysipeloid due to Erysipelothrix rhusiopathiae
- Rat-bite fever due to susceptible Streptobacillus moniliformis and Spirillum minus organisms
Usual Adult Dose for Anthrax Prophylaxis
1.2 million units IM every 12 hours
Total duration of therapy: 60 days
Comments:
- Safety of this drug at this dose has not been established for more than 2 weeks of use; the risks/benefits of continuing this drug beyond 2 weeks or switching to an effective alternate therapy should be considered.
Use: Inhalational anthrax (postexposure) to reduce incidence/progression of infection after exposure to aerosolized Bacillus anthracis
Usual Adult Dose for Neurosyphilis
600,000 units/day IM for 10 to 15 days
Total dosage: 6 to 9 million units
Use: Late syphilis (tertiary, neurosyphilis) due to susceptible Treponema pallidum
US CDC and Panel on Opportunistic Infections in Adults and Adolescents with HIV Recommendations: 2.4 million units IM once a day for 10 to 14 days
Comments:
- US CDC: If compliance can be ensured, recommended with probenecid as an alternative regimen for neurosyphilis
- Panel on Opportunistic Infections in Adults and Adolescents with HIV: Recommended with probenecid as alternative therapy for neurosyphilis or otic or ocular syphilis
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Tertiary Syphilis
600,000 units/day IM for 10 to 15 days
Total dosage: 6 to 9 million units
Use: Late syphilis (tertiary, neurosyphilis) due to susceptible Treponema pallidum
US CDC and Panel on Opportunistic Infections in Adults and Adolescents with HIV Recommendations: 2.4 million units IM once a day for 10 to 14 days
Comments:
- US CDC: If compliance can be ensured, recommended with probenecid as an alternative regimen for neurosyphilis
- Panel on Opportunistic Infections in Adults and Adolescents with HIV: Recommended with probenecid as alternative therapy for neurosyphilis or otic or ocular syphilis
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Syphilis - Latent
With a negative spinal fluid: 600,000 units/day IM for 8 days
Total dosage: 4,800,000 units
With positive or no spinal fluid examination: 600,000 units/day IM for 10 to 15 days
Total dosage: 6 to 9 million units
Use: Latent syphilis due to susceptible T pallidum
Usual Adult Dose for Syphilis - Early
600,000 units/day IM for 8 days
Total dosage: 4,800,000 units
Uses: Primary and secondary syphilis due to susceptible T pallidum
Usual Adult Dose for Bejel
The usual treatment is the same as for syphilis in the corresponding stage of disease.
Uses: Bejel, pinta, yaws due to susceptible organisms
Usual Adult Dose for Yaws
The usual treatment is the same as for syphilis in the corresponding stage of disease.
Uses: Bejel, pinta, yaws due to susceptible organisms
Usual Adult Dose for Pinta
The usual treatment is the same as for syphilis in the corresponding stage of disease.
Uses: Bejel, pinta, yaws due to susceptible organisms
Usual Adult Dose for Diphtheria
Adjunctive therapy with antitoxin: 300,000 to 600,000 units/day IM
Carrier state: 300,000 units/day IM for 10 days
Uses: Adjunct to antitoxin for prevention of carrier stage of diphtheria due to susceptible Corynebacterium diphtheriae; diphtheria carrier state
US CDC Recommendations: 600,000 units every 12 hours for 14 days
Comments:
- Antimicrobial therapy is necessary to stop toxin production, eradicate C diphtheriae organism, and prevent transmission; it is not a substitute for antitoxin.
- Patients usually are not contagious 48 hours after starting therapy.
- Eradication of the organism should be confirmed 24 hours after completion of therapy by 2 consecutive negative cultures from specimens taken 24 hours apart.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Pneumonia
Less than 27 kg: 300,000 units/day IM
Uses:
- Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
- Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses
- Maximum dose: 1.2 million units/day
Comments:
- This drug is not safe for IV administration.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Skin or Soft Tissue Infection
Less than 27 kg: 300,000 units/day IM
Uses:
- Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
- Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses
- Maximum dose: 1.2 million units/day
Comments:
- This drug is not safe for IV administration.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Upper Respiratory Tract Infection
Less than 27 kg: 300,000 units/day IM
Uses:
- Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
- Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses
- Maximum dose: 1.2 million units/day
Comments:
- This drug is not safe for IV administration.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Bacterial Infection
Less than 27 kg: 300,000 units/day IM
Uses:
- Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
- Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses
- Maximum dose: 1.2 million units/day
Comments:
- This drug is not safe for IV administration.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Streptococcal Infection
Less than 27 kg: 300,000 units/day IM
Uses:
- Pneumonia/moderately severe infections of the respiratory tract due to susceptible pneumococci
- Streptococcal (group A) infections/moderately severe to severe infections of the upper respiratory tract, skin and soft tissue infections, scarlet fever, and erysipelas due to susceptible streptococci (group A without bacteremia)
- Staphylococcal infections/moderately severe infections of the skin and soft tissues due to susceptible staphylococci (penicillin G-susceptible)
American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50,000 units/kg IM every 24 hours
1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses
- Maximum dose: 1.2 million units/day
Comments:
- This drug is not safe for IV administration.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Anthrax Prophylaxis
Children: 25,000 units/kg IM every 12 hours
- Maximum dose: 1.2 million units/dose
Comments:
- Safety of this drug at this dose has not been established for more than 2 weeks of use; the risks/benefits of continuing this drug beyond 2 weeks or switching to an effective alternate therapy should be considered.
Use: Inhalational anthrax (postexposure) to reduce incidence/progression of infection after exposure to aerosolized B anthracis
Usual Pediatric Dose for Congenital Syphilis
Less than 32 kg: 50,000 units/kg/day IM for 10 days
US CDC and AAP Recommendations: 50,000 units/kg IM once a day for 10 days
- Maximum dose: 2.4 million units/day
Comments:
- Recommended for neonates with proven or highly probable congenital syphilis, neonates with possible congenital syphilis, and neonates with or without clinical evidence of congenital syphilis (proven/highly probable, possible, or less likely) when aqueous crystalline penicillin G is unavailable
- Recommended for infants and children with or without clinical evidence of congenital syphilis (proven/highly probable, possible, or less likely) when aqueous crystalline penicillin G is unavailable
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Syphilis - Early
Greater than 12 years: 600,000 units/day IM for 8 days
Total dosage: 4,800,000 units
Use: Primary, secondary, and latent with a negative spinal fluid
Usual Pediatric Dose for Syphilis - Latent
Greater than 12 years: 600,000 units/day IM for 8 days
Total dosage: 4,800,000 units
Use: Primary, secondary, and latent with a negative spinal fluid
Usual Pediatric Dose for Neurosyphilis
Panel on Opportunistic Infections in Adults and Adolescents with HIV Recommendations: 2.4 million units IM once a day for 10 to 14 days
Comments:
- Recommended with probenecid as alternative therapy for neurosyphilis or otic or ocular syphilis in adolescents
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Diphtheria
US CDC Recommendations:
- Up to 10 kg: 300,000 units IM every 12 hours
- Greater than 10 kg: 600,000 units IM every 12 hours
AAP Recommendations:
- Aged 1 month or older: 50,000 units/kg/day IM divided in 1 or 2 doses
- Maximum dose: 1.2 million units/day
Duration of Therapy: 14 days
Comments:
- Antimicrobial therapy is necessary to stop toxin production, eradicate C diphtheriae organism, and prevent transmission; it is not a substitute for antitoxin.
- Patients usually are not contagious 48 hours after starting therapy.
- Eradication of the organism should be confirmed 24 hours after completion of therapy by 2 consecutive negative cultures from specimens taken 24 hours apart.
- Current guidelines should be consulted for additional information.
Renal Dose Adjustments
Data not available
Comments:
- Excretion is considerably delayed in patients with impaired renal function.
Liver Dose Adjustments
Data not available
Precautions
US BOXED WARNING:
- The warnings, adverse reactions, and dosage and administration sections of the manufacturer product information should be carefully read before administering this drug.
CONTRAINDICATIONS:
Previous hypersensitivity reaction to any penicillin
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- For IM injection only; do not inject into or near an artery or nerve; may cause permanent neurologic damage if injected into or near a nerve
- Administer by deep IM injection in the upper, outer quadrant of the buttock (dorsogluteal) or the ventrogluteal site; may prefer the midlateral aspect of the thigh in neonates, infants, and small children
- The needle may be blocked if the drug is not injected at a slow, steady rate (due to high concentration of suspended material in product).
- Rotate the injection site when doses are repeated.
- Do not use this drug for severe infections (e.g., severe pneumonia, empyema, bacteremia [including streptococcal infections with bacteremia], pericarditis, meningitis, peritonitis, pneumococcal arthritis) during the acute stage or when high, sustained serum drug levels are required; use aqueous penicillin G (IM or IV).
- Do not use this drug for prophylaxis against bacterial endocarditis; use penicillin V (or aqueous penicillin G if patient unable to take oral medications) when prophylaxis is necessary.
- Do not use this drug to treat beta-lactamase-producing organisms (including most strains of Neisseria gonorrhoeae); this drug is no longer indicated to treat gonorrhea.
Storage requirements:
- Store in refrigerator at 2C to 8C (36F to 46F); keep from freezing.
General:
- To reduce the development of drug-resistant organisms and maintain effective therapy, antibiotics should be used only to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria.
- Culture and susceptibility information should be considered when selecting/modifying antibacterial therapy or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.
- This drug should only be used for indications listed in the manufacturer product information; this drug is for the treatment of moderately severe infections due to penicillin-G-sensitive microorganisms susceptible to the low and persistent serum levels typical of this formulation.
- Bacteriological studies (including susceptibility tests) and clinical response should guide therapy.
- Groups A, C, G, H, L, and M streptococci are very susceptible to penicillin G; other groups (including group D [enterococci]) are resistant; aqueous penicillin is recommended for streptococcal infections with bacteremia.
- An increasing number of strains of staphylococci are resistant to penicillin G, emphasizing the importance of culture and sensitivity studies when treating suspected staphylococcal infections; indicated surgical procedures should be performed.
- Completion of necessary dental care recommended with infections involving gum tissue.
- Excretion is considerably delayed in neonates and young infants.
Monitoring:
- General: Laboratory studies, including susceptibility tests with suspected staphylococcal infections; serological tests if concomitant syphilis suspected (monthly for at least 4 months)
- Hematologic: Hematopoietic systems (during prolonged therapy, especially with high-dose regimens)
- Renal: Renal systems (during prolonged therapy, especially with high-dose regimens); renal function in elderly patients
Patient advice:
- Avoid missing doses and complete the entire course of therapy.
- Seek immediate medical attention if the following signs/symptoms develop: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.
- Consult physician at once if watery and bloody stools (with or without stomach cramps and fever) develop.
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