Drug Class: Natural penicillins
Usual Adult Dose for Skin or Soft Tissue Infection
Bicillin C-R: 2,400,000 units IM once
Comments:
- The recommended dose is generally administered at 1 session using multiple IM sites (as indicated).
- An alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci
Usual Adult Dose for Upper Respiratory Tract Infection
Bicillin C-R: 2,400,000 units IM once
Comments:
- The recommended dose is generally administered at 1 session using multiple IM sites (as indicated).
- An alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci
Usual Adult Dose for Streptococcal Infection
Bicillin C-R: 2,400,000 units IM once
Comments:
- The recommended dose is generally administered at 1 session using multiple IM sites (as indicated).
- An alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci
Usual Adult Dose for Otitis Media
Bicillin C-R: 1,200,000 units IM repeated every 2 or 3 days
Duration of therapy: Until temperature is normal for 48 hours
Comments:
- Other forms of penicillin may be needed for severe cases.
Uses: For the treatment of moderately severe pneumonia and otitis media due to susceptible Streptococcus pneumoniae; for pneumococcal infections (except pneumococcal meningitis)
Usual Adult Dose for Pneumonia
Bicillin C-R: 1,200,000 units IM repeated every 2 or 3 days
Duration of therapy: Until temperature is normal for 48 hours
Comments:
- Other forms of penicillin may be needed for severe cases.
Uses: For the treatment of moderately severe pneumonia and otitis media due to susceptible Streptococcus pneumoniae; for pneumococcal infections (except pneumococcal meningitis)
Usual Pediatric Dose for Skin or Soft Tissue Infection
Bicillin C-R:
- Weight less than 13.6 kg: 600,000 units IM once
- Weight 13.6 to 27.3 kg: 900,000 to 1,200,000 units IM once
- Weight 27.3 kg or more: 2,400,000 units IM once
Bicillin C-R 900/300: 1,200,000 units IM once
Comments:
- Bicillin C-R: The recommended dose is generally administered at 1 session using multiple IM sites (as indicated); an alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
- Bicillin C-R 900/300: A single injection is usually sufficient.
Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci
American Academy of Pediatrics Recommendations:
Bicillin C-R:
1 month or older:
- Weight less than 14 kg: 600,000 units IM once
- Weight 14 to 27 kg: 1,200,000 units IM once
- Weight 27 kg or more: 2,400,000 units IM once
Comments:
- Major use is the treatment of group A streptococcal infections
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Upper Respiratory Tract Infection
Bicillin C-R:
- Weight less than 13.6 kg: 600,000 units IM once
- Weight 13.6 to 27.3 kg: 900,000 to 1,200,000 units IM once
- Weight 27.3 kg or more: 2,400,000 units IM once
Bicillin C-R 900/300: 1,200,000 units IM once
Comments:
- Bicillin C-R: The recommended dose is generally administered at 1 session using multiple IM sites (as indicated); an alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
- Bicillin C-R 900/300: A single injection is usually sufficient.
Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci
American Academy of Pediatrics Recommendations:
Bicillin C-R:
1 month or older:
- Weight less than 14 kg: 600,000 units IM once
- Weight 14 to 27 kg: 1,200,000 units IM once
- Weight 27 kg or more: 2,400,000 units IM once
Comments:
- Major use is the treatment of group A streptococcal infections
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Streptococcal Infection
Bicillin C-R:
- Weight less than 13.6 kg: 600,000 units IM once
- Weight 13.6 to 27.3 kg: 900,000 to 1,200,000 units IM once
- Weight 27.3 kg or more: 2,400,000 units IM once
Bicillin C-R 900/300: 1,200,000 units IM once
Comments:
- Bicillin C-R: The recommended dose is generally administered at 1 session using multiple IM sites (as indicated); an alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
- Bicillin C-R 900/300: A single injection is usually sufficient.
Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci
American Academy of Pediatrics Recommendations:
Bicillin C-R:
1 month or older:
- Weight less than 14 kg: 600,000 units IM once
- Weight 14 to 27 kg: 1,200,000 units IM once
- Weight 27 kg or more: 2,400,000 units IM once
Comments:
- Major use is the treatment of group A streptococcal infections
- Current guidelines should be consulted for additional information.
Usual Pediatric Dose for Otitis Media
Bicillin C-R: 600,000 units IM repeated every 2 or 3 days
Bicillin C-R 900/300: 1,200,000 units IM repeated every 2 or 3 days
Duration of therapy: Until temperature is normal for 48 hours
Comments:
- Other forms of penicillin may be needed for severe cases.
Uses: For the treatment of moderately severe pneumonia and otitis media due to susceptible S pneumoniae; for pneumococcal infections (except pneumococcal meningitis)
Usual Pediatric Dose for Pneumonia
Bicillin C-R: 600,000 units IM repeated every 2 or 3 days
Bicillin C-R 900/300: 1,200,000 units IM repeated every 2 or 3 days
Duration of therapy: Until temperature is normal for 48 hours
Comments:
- Other forms of penicillin may be needed for severe cases.
Uses: For the treatment of moderately severe pneumonia and otitis media due to susceptible S pneumoniae; for pneumococcal infections (except pneumococcal meningitis)
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Data not available
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 penicillin G benzathine 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 penicillin or to procaine
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
- 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 IM or IV penicillin G sodium/potassium instead.
- Do not use this drug in the treatment of venereal diseases (including syphilis, gonorrhea, yaws, bejel, pinta).
Storage requirements:
- Store in refrigerator between 2C to 8C (36F to 46F); keep from freezing.
General:
- 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 serum levels typical of this formulation (lower but more prolonged than other parenteral penicillins).
- Bacteriological studies (including susceptibility testing) 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.
- 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.
- Bicillin C-R: Each 2 mL syringe contains the equivalent of 1,200,000 units of penicillin G with 600,000 units of penicillin G as the benzathine salt and 600,000 units of penicillin G as the procaine salt.
- Bicillin C-R 900/300: Each 2 mL syringe contains the equivalent of 1,200,000 units of penicillin G with 900,000 units of penicillin G as the benzathine salt and 300,000 units of penicillin G as the procaine salt; this product is only indicated in pediatric patients.
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.
- 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.
