Drug Detail:Penicillin g benzathine (Penicillin g benzathine [ pen-i-sill-in-g-ben-za-theen ])
Drug Class: Natural penicillins
Usual Adult Dose for Pharyngitis
1.2 million units IM as a single dose
Uses: For the treatment of mild to moderate upper respiratory tract infections (URTIs) due to susceptible group A streptococci (e.g., pharyngitis); for the treatment of URTIs (pharyngitis) due to group A streptococci (without bacteremia)
Infectious Diseases Society of America (IDSA) and American Heart Association (AHA) Recommendations: 1.2 million units IM as a single dose
Comments:
- Preferred for patients with group A streptococcal pharyngitis who are considered unlikely to complete 10 days of oral therapy
- IDSA: This drug plus 4 days of oral rifampin are recommended for chronic carriers of group A streptococci.
- AHA: Recommended for the treatment of streptococcal tonsillopharyngitis (primary prevention of rheumatic fever)
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Upper Respiratory Tract Infection
1.2 million units IM as a single dose
Uses: For the treatment of mild to moderate upper respiratory tract infections (URTIs) due to susceptible group A streptococci (e.g., pharyngitis); for the treatment of URTIs (pharyngitis) due to group A streptococci (without bacteremia)
Infectious Diseases Society of America (IDSA) and American Heart Association (AHA) Recommendations: 1.2 million units IM as a single dose
Comments:
- Preferred for patients with group A streptococcal pharyngitis who are considered unlikely to complete 10 days of oral therapy
- IDSA: This drug plus 4 days of oral rifampin are recommended for chronic carriers of group A streptococci.
- AHA: Recommended for the treatment of streptococcal tonsillopharyngitis (primary prevention of rheumatic fever)
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Tonsillitis/Pharyngitis
1.2 million units IM as a single dose
Uses: For the treatment of mild to moderate upper respiratory tract infections (URTIs) due to susceptible group A streptococci (e.g., pharyngitis); for the treatment of URTIs (pharyngitis) due to group A streptococci (without bacteremia)
Infectious Diseases Society of America (IDSA) and American Heart Association (AHA) Recommendations: 1.2 million units IM as a single dose
Comments:
- Preferred for patients with group A streptococcal pharyngitis who are considered unlikely to complete 10 days of oral therapy
- IDSA: This drug plus 4 days of oral rifampin are recommended for chronic carriers of group A streptococci.
- AHA: Recommended for the treatment of streptococcal tonsillopharyngitis (primary prevention of rheumatic fever)
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Streptococcal Infection
1.2 million units IM as a single dose
Uses: For the treatment of mild to moderate upper respiratory tract infections (URTIs) due to susceptible group A streptococci (e.g., pharyngitis); for the treatment of URTIs (pharyngitis) due to group A streptococci (without bacteremia)
Infectious Diseases Society of America (IDSA) and American Heart Association (AHA) Recommendations: 1.2 million units IM as a single dose
Comments:
- Preferred for patients with group A streptococcal pharyngitis who are considered unlikely to complete 10 days of oral therapy
- IDSA: This drug plus 4 days of oral rifampin are recommended for chronic carriers of group A streptococci.
- AHA: Recommended for the treatment of streptococcal tonsillopharyngitis (primary prevention of rheumatic fever)
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Rheumatic Fever Prophylaxis
1.2 million units IM once a month or 600,000 units IM every 2 weeks
Comments:
- Prophylaxis with this drug is effective in preventing recurrence of rheumatic fever and/or chorea.
- This drug has been used as follow-up prophylactic therapy for rheumatic heart disease.
Uses: Prophylaxis against rheumatic fever and/or chorea recurrence; prophylaxis for rheumatic fever after an acute attack
AHA Recommendations: 1.2 million units IM every 3 to 4 weeks
Duration of secondary prophylaxis (after last attack):
- Rheumatic fever with carditis and residual heart disease (persistent valvular disease): 10 years or until 40 years of age (whichever is longer); sometimes lifelong prophylaxis
- Rheumatic fever with carditis and no residual heart disease (no valvular disease): 10 years or until 21 years of age (whichever is longer)
- Rheumatic fever without carditis: 5 years or until 21 years of age (whichever is longer)
Comments:
- Recommended for secondary prevention of rheumatic fever (prevention of recurrent attacks)
- Use every 4 weeks is appropriate for most situations; use every 3 weeks is justified and recommended for high-risk situations.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Syphilis - Early
2.4 million units IM as a single dose
Uses: For the treatment of primary, secondary, and latent syphilis
US CDC Recommendations:
- Primary, secondary, and early latent syphilis: 2.4 million units IM as a single dose
- Retreatment of primary or secondary syphilis (without neurosyphilis): 2.4 million units IM once a week for 3 weeks
- Late latent syphilis or latent of unknown duration: 2.4 million units IM once a week for 3 weeks (total dose: 7.2 million units)
Comments:
- A second dose (2.4 million units IM) can be administered 1 week after the initial dose to pregnant women with primary, secondary, or early latent syphilis.
- The patient's sexual partner(s) should also be evaluated/treated.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Syphilis - Latent
2.4 million units IM as a single dose
Uses: For the treatment of primary, secondary, and latent syphilis
US CDC Recommendations:
- Primary, secondary, and early latent syphilis: 2.4 million units IM as a single dose
- Retreatment of primary or secondary syphilis (without neurosyphilis): 2.4 million units IM once a week for 3 weeks
- Late latent syphilis or latent of unknown duration: 2.4 million units IM once a week for 3 weeks (total dose: 7.2 million units)
Comments:
- A second dose (2.4 million units IM) can be administered 1 week after the initial dose to pregnant women with primary, secondary, or early latent syphilis.
- The patient's sexual partner(s) should also be evaluated/treated.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Neurosyphilis
Bicillin L-A: 2.4 million units IM once a week for 3 doses
Permapen: 3 million units IM once a week for 2 to 3 doses (total dose: 6 to 9 million units)
Use: For the treatment of late syphilis (tertiary and neurosyphilis)
US CDC Recommendations:
- Tertiary syphilis with normal CSF examination: 2.4 million units IM once a week for 3 weeks (total dose: 7.2 million units)
- Neurosyphilis (after completing recommended or alternative regimen):2.4 million units IM once a week for up to 3 weeks
Comments:
- Use of this drug can be considered after completing the recommended (aqueous penicillin G) or alternative (procaine penicillin plus probenecid) regimen for neurosyphilis to provide comparable total duration of therapy.
- The patient's sexual partner(s) should also be evaluated/treated.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Tertiary Syphilis
Bicillin L-A: 2.4 million units IM once a week for 3 doses
Permapen: 3 million units IM once a week for 2 to 3 doses (total dose: 6 to 9 million units)
Use: For the treatment of late syphilis (tertiary and neurosyphilis)
US CDC Recommendations:
- Tertiary syphilis with normal CSF examination: 2.4 million units IM once a week for 3 weeks (total dose: 7.2 million units)
- Neurosyphilis (after completing recommended or alternative regimen):2.4 million units IM once a week for up to 3 weeks
Comments:
- Use of this drug can be considered after completing the recommended (aqueous penicillin G) or alternative (procaine penicillin plus probenecid) regimen for neurosyphilis to provide comparable total duration of therapy.
- The patient's sexual partner(s) should also be evaluated/treated.
- Current guidelines should be consulted for additional information.
Usual Adult Dose for Bejel
1.2 million units IM as a single dose
Usual Adult Dose for Yaws
1.2 million units IM as a single dose
Usual Adult Dose for Pinta
1.2 million units IM as a single dose
Usual Adult Dose for Glomerulonephritis
1.2 million units IM once a month or 600,000 units IM every 2 weeks
Comments:
- This drug has been used as follow-up prophylactic therapy for acute glomerulonephritis.
Use: Prophylaxis for glomerulonephritis after an acute attack
Usual Pediatric Dose for Pharyngitis
Infants and pediatric patients less than 27.3 kg: 300,000 to 600,000 units IM as a single dose
Older pediatric patients: 900,000 units IM as a single dose
Uses: For the treatment of mild to moderate URTIs due to susceptible group A streptococci (e.g., pharyngitis); for the treatment of URTIs (pharyngitis) due to group A streptococci (without bacteremia)
IDSA Recommendations:
- Children less than 27 kg: 600,000 units IM as a single dose
- Patients at least 27 kg: 1.2 million units IM as a single dose
AHA and American Academy of Pediatrics (AAP) Recommendations:
- Children up to 27 kg: 600,000 units IM once
- Patients greater than 27 kg: 1.2 million units IM once
Comments:
- Preferred for patients with group A streptococcal pharyngitis who are considered unlikely to complete 10 days of oral therapy
- IDSA: This drug plus 4 days of oral rifampin are recommended for chronic carriers of group A streptococci.
- AHA, AAP: Recommended for the treatment of streptococcal tonsillopharyngitis (primary prevention of rheumatic fever)
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Upper Respiratory Tract Infection
Infants and pediatric patients less than 27.3 kg: 300,000 to 600,000 units IM as a single dose
Older pediatric patients: 900,000 units IM as a single dose
Uses: For the treatment of mild to moderate URTIs due to susceptible group A streptococci (e.g., pharyngitis); for the treatment of URTIs (pharyngitis) due to group A streptococci (without bacteremia)
IDSA Recommendations:
- Children less than 27 kg: 600,000 units IM as a single dose
- Patients at least 27 kg: 1.2 million units IM as a single dose
AHA and American Academy of Pediatrics (AAP) Recommendations:
- Children up to 27 kg: 600,000 units IM once
- Patients greater than 27 kg: 1.2 million units IM once
Comments:
- Preferred for patients with group A streptococcal pharyngitis who are considered unlikely to complete 10 days of oral therapy
- IDSA: This drug plus 4 days of oral rifampin are recommended for chronic carriers of group A streptococci.
- AHA, AAP: Recommended for the treatment of streptococcal tonsillopharyngitis (primary prevention of rheumatic fever)
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Tonsillitis/Pharyngitis
Infants and pediatric patients less than 27.3 kg: 300,000 to 600,000 units IM as a single dose
Older pediatric patients: 900,000 units IM as a single dose
Uses: For the treatment of mild to moderate URTIs due to susceptible group A streptococci (e.g., pharyngitis); for the treatment of URTIs (pharyngitis) due to group A streptococci (without bacteremia)
IDSA Recommendations:
- Children less than 27 kg: 600,000 units IM as a single dose
- Patients at least 27 kg: 1.2 million units IM as a single dose
AHA and American Academy of Pediatrics (AAP) Recommendations:
- Children up to 27 kg: 600,000 units IM once
- Patients greater than 27 kg: 1.2 million units IM once
Comments:
- Preferred for patients with group A streptococcal pharyngitis who are considered unlikely to complete 10 days of oral therapy
- IDSA: This drug plus 4 days of oral rifampin are recommended for chronic carriers of group A streptococci.
- AHA, AAP: Recommended for the treatment of streptococcal tonsillopharyngitis (primary prevention of rheumatic fever)
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Streptococcal Infection
Infants and pediatric patients less than 27.3 kg: 300,000 to 600,000 units IM as a single dose
Older pediatric patients: 900,000 units IM as a single dose
Uses: For the treatment of mild to moderate URTIs due to susceptible group A streptococci (e.g., pharyngitis); for the treatment of URTIs (pharyngitis) due to group A streptococci (without bacteremia)
IDSA Recommendations:
- Children less than 27 kg: 600,000 units IM as a single dose
- Patients at least 27 kg: 1.2 million units IM as a single dose
AHA and American Academy of Pediatrics (AAP) Recommendations:
- Children up to 27 kg: 600,000 units IM once
- Patients greater than 27 kg: 1.2 million units IM once
Comments:
- Preferred for patients with group A streptococcal pharyngitis who are considered unlikely to complete 10 days of oral therapy
- IDSA: This drug plus 4 days of oral rifampin are recommended for chronic carriers of group A streptococci.
- AHA, AAP: Recommended for the treatment of streptococcal tonsillopharyngitis (primary prevention of rheumatic fever)
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Rheumatic Fever Prophylaxis
AHA Recommendations:
- Children up to 27 kg: 600,000 units IM every 3 to 4 weeks
- Patients greater than 27 kg: 1.2 million units IM every 3 to 4 weeks
Duration of secondary prophylaxis (after last attack):
- Rheumatic fever with carditis and residual heart disease (persistent valvular disease): 10 years or until 40 years of age (whichever is longer); sometimes lifelong prophylaxis
- Rheumatic fever with carditis and no residual heart disease (no valvular disease): 10 years or until 21 years of age (whichever is longer)
- Rheumatic fever without carditis: 5 years or until 21 years of age (whichever is longer)
Comments:
- Recommended for secondary prevention of rheumatic fever (prevention of recurrent attacks)
- Use every 4 weeks is appropriate for most situations; use every 3 weeks is justified and recommended for high-risk situations.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Congenital Syphilis
Less than 2 years: 50,000 units/kg IM as a single dose
2 to 12 years: Adjust dose based on adult dose schedule
Use: For the treatment of congenital syphilis (asymptomatic with normal CSF)
US CDC Recommendations:
Neonates:
- If congenital syphilis possible, less likely, or unlikely: 50,000 units/kg IM as a single dose
- Without any clinical evidence of infection (congenital syphilis possible or less likely): 50,000 units/kg IM as a single dose
Infants and children:
- If no clinical symptoms and normal evaluation: 50,000 units/kg IM once a week for up to 3 weeks
- If clinical evidence of congenital syphilis (after completing the recommended 10-day regimen): 50,000 units/kg IM as a single dose
- Without any clinical evidence of infection (congenital syphilis possible or less likely): 50,000 units/kg IM as a single dose
Maximum dose: 2.4 million units/dose
Comments:
- If possible congenital syphilis, neonates should be treated with this drug or another recommended regimen; before using this single-dose regimen, the complete evaluation (i.e., CSF analysis, long-bone radiographs, CBC with platelets) must be normal, and follow-up must be assured; if any part of the evaluation is abnormal/not performed, if the CSF analysis cannot be interpreted due to contamination with blood, or if follow-up is uncertain, 10 days of penicillin G is required. If the nontreponemal test is nonreactive and the mother's risk of untreated syphilis is deemed low, may consider the single-dose regimen to treat neonates for possible incubating syphilis without an evaluation
- If congenital syphilis is less likely, an alternative to treatment with this drug is close serologic follow-up (every 2 to 3 months for 6 months) for a neonate whose mother's nontreponemal titers declined at least 4-fold after appropriate therapy for early syphilis or remained stable for low-titer, latent syphilis.
- Treatment is not required if congenital syphilis is unlikely; use of this drug may be considered, especially if follow-up uncertain and neonate has reactive nontreponemal test.
- Infants and children with no clinical symptoms of congenital syphilis and whose evaluation (including CSF analysis) is normal: Use of this drug can be considered; a single dose can be considered after completing the recommended regimen (IV aqueous penicillin G for 10 days) to provide more comparable duration of therapy.
- Infants and children with clinical evidence of congenital syphilis: A single dose can be considered after completing the recommended regimen (procaine penicillin G for 10 days).
- Infants and children without any clinical evidence of infection: A single dose can be considered.
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Syphilis - Early
US CDC Recommendations:
1 month or older:
- Primary, secondary, and early latent syphilis: 50,000 units/kg IM as a single dose
- Late latent syphilis: 50,000 units/kg IM once a week for 3 weeks (total dose: 150,000 units/kg)
Comments:
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Syphilis - Latent
US CDC Recommendations:
1 month or older:
- Primary, secondary, and early latent syphilis: 50,000 units/kg IM as a single dose
- Late latent syphilis: 50,000 units/kg IM once a week for 3 weeks (total dose: 150,000 units/kg)
Comments:
- Current guidelines should be consulted for additional information.
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Data not available
Dose Adjustments
In children younger than 12 years, dose should be adjusted according to age and weight of the child and severity of the infection.
Precautions
US BOXED WARNING:
- ADMINISTRATION: This drug is not for IV use; it must not be injected IV or admixed with other IV solutions. Inadvertent IV administration of this drug has been associated with cardiorespiratory arrest and death. The manufacturer product information should be consulted before administering this drug.
CONTRAINDICATIONS:
Previous hypersensitivity reaction to any of the penicillins
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; do not inject IV or admix with other IV solutions.
- 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; for patients younger than 2 years, may divide the dose between the 2 buttocks if needed
- 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.
Storage requirements:
- Store in refrigerator between 2C to 8C (36F to 46F)
- Keep from freezing.
General:
- This drug is for the treatment of infections due to penicillin-G-sensitive microorganisms susceptible to low and very prolonged serum drug levels.
- Bacteriological studies (including sensitivity testing) and clinical response should guide therapy.
- In streptococcal infections, therapy should be sufficient to eradicate the organism, otherwise streptococcal disease sequelae may occur; cultures should be taken after completion of therapy to verify streptococci have been eliminated.
- 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.
Monitoring:
- 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.
- Consult physician at once if watery and bloody stools (with or without stomach cramps and fever) develop.
