Penicillin benzathine

Benzathine penicillin 2.4 million units intramuscularly Desensitize penicillin-allergic patients during pregnancy ... 

Treat syphilis during lactation with benzathine penicillin G or any of the CDC-recommended alternatives for penicillin-allergic patients (Table 44-5). All choices are deemed compatible with breast-feeding by the AAP.14... 

Children with SCD should receive prophylactic penicillin until at least the age of 5 years, even if they have been immunized appropriately with PCV 7 against pneumococcal infections. Penicillin V potassium typically is initiated at age 2 months with a dose of 125 mg orally twice daily until age 3 years and then 250 mg orally twice daily until 5 years of age. The intramuscular use of benzathine penicillin 600,000 units every 4 weeks from age 6 months to 6 years is also an option for non-compliant patients. Penicillin-allergic patients may receive erythromycin 10 mg/kg twice daily. Penicillin prophylaxis usually is not continued in children over the age of 6 years but may be considered in patients with a history of invasive pneumococcal infection or surgical splenectomy.6,18-20... 

Pertinent information related to benzathine penicillin G is found in Table 77-1. 

Drug of choice Benzathine penicillin, 2.4 million units intramuscularly as a single dose. 

Benzathine Penicillin G, 2.4 million units IM (single dose) ... 

Benzathine Penicillin G, 2A million units IM once weekly for 3 weeks (three doses)... 

Drug of choice Benzathine penicillin G 2.4 million units or 7.2 million units intramuscularly over 3 weeks if the duration of syphilis has been at least a year... 

Asymptomatic neonates 50,000 U/kg of benzathine penicillin G in a single intramuscular dose... 

In patients who are both negative for HIV and the lumbar puncture, administer benzathine penicillin G 2.4 million units intramuscularly once weekly for 3 additional weeks. Perform a patient follow-up in 6 months including a clinical examination and another non-treponemal titer. In HIVnegative patients with lumbar puncture findings compatible with neurosyphilis, treat the patient accordingly for neurosyphilis. 

Prophylactic penicillin is recommended for children with SCD until they are 5 years old. Beginning at age 2 months or earlier, the dosage is penicillin V potassium, 125 mg orally twice daily until 3 years of age and then 250 mg twice daily until age 5 years, or benzathine penicillin, 600,000 units intramuscularly every 4 weeks from age 6 months to 6 years. 

Doxycycline6 or fluoroquinolone 0 Spirochetes Treponema pallidum Neurosyphilis Penicillin G Ceftriaxone0 Primary or secondary Benzathine penicillin G Doxycyclinee or ceftriaxone0... 

Either aqueous penicillin G or benzathine penicillin G (pharyngitis only). 

If patients are unable to take oral medications, intramuscular benzathine penicillin can be given although it is painful and no longer available in Canada. 

Treatment recommendations from the CDC for syphilis are presented in Table 46-6. Parenteral penicillin G is the treatment of choice for all stages of syphilis. Benzathine penicillin G is the only penicillin effective for single-dose therapy. 

For pregnant patients, penicillin is the treatment of choice at the dosage recommended for that particular stage of syphilis. To ensure treatment success and prevent transmission to the fetus, some experts advocate an additional intramuscular dose of benzathine penicillin G, 2.4 million units, 1 week after completion of the recommended regimen. 

Benzathine penicillin G 2.4 million units IM in a single dosec... 

Some experts administer benzathine penicillin G 2.4 million units IM once per week for up to 3 weeks after completion of the neurosyphilis regimens to provide a total duration of therapy comparable to that used for late syphilis in the absence of neurosyphilis. For nonpregnant patients pregnant patients should be treated with penicillin after desensitization. 

Aqueous penicillin G, 18 to 24 million units/day IV (3 to 4 million units every 4 h) for 10 to 14 days. Many recommend benzathine penicillin G, 2.4 million IM units once/wk for up to 3 wk following completion of this regimen. 

Children and young adults with a history of rheumatic fever are given monthly benzathin-penicillin injections or oral penicillin to prevent recurrent attacks of rheumatic fever (secondary prevention of rheumatic cardiac disease). 

Depot intramuscular formulations of penicillin G, including procaine penicillin and benzathine penicillin, have decreased solubility, delayed absorption, and a prolonged half-life. Drug concentrations are detectable 24 hours after injection of procaine penicillin, and low levels of benzathine penicillin (0.003 units/mL) are detectable 4 weeks after injection. 

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