Penicillin benzathine dosing

Penicillin benzathine 12 million units intramuscularly 0,6 million units for under 27 kg (50,000 units/kg) One dose... 

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... 

Penicillin G benzathine 1.2 million units 600,000 units (if under 27 kg) 1 IM dose Useful for nonadherence or emesis painful injection... 

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)... 

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

Penicillin G procaine and benzathine mixture Not recommended in adolescents and adults 12 million units (benzathine 0,9 million units, procaine 03 million units) One dose... 

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. 

PENICILLIN G BENZATHINE, IM Administer by deep IM injection in the upper outer quadrant of the buttock. In neonates, infants, and small children, the midlateral aspect of the thigh may be preferable. When doses are repeated, rotate the injection site. Do not administer IV. 

Benzathine and procaine penicillins are formulated to delay absorption, resulting in prolonged blood and tissue concentrations. A single intramuscular injection of 1.2 million units of benzathine penicillin maintains serum levels above 0.02 mcg/mL for 10 days, sufficient to treat B-hemolytic streptococcal infection. After 3 weeks, levels still exceed 0.003 mcg/mL, which is enough to prevent B-hemolytic streptococcal infection. A 600,000 unit dose of procaine penicillin yields peak concentrations of 1-2 mcg/mL and clinically useful concentrations for 12-24 hours after a single intramuscular injection. 

This scenario is based on a true story that demonstrates the multiple breakdowns that can occur during the medication use process that led to the death of an infant. An infant was born to a mother with a prior history of syphilis. Despite having incomplete patient information about the mothers past treatment for syphilis and the current status of both the mother and the child, a decision was made to treat the infant for congenital syphilis. After phone consultation with infectious disease specialists and the health department, an order was written for one dose of benzathine penicillin G 150,000 units IM. ... 

The physicians, nurses, and pharmacists, unfamiliar with the treatment of congenital syphilis, also had limited knowledge about this medication. The pharmacist consulted Drug Facts and Comparisons to determine the usual dose of penicillin G benzathine for an infant. However, she misread the dose as... 

Some experts recommend multiple doses of benzathine penicillin C or other supplemental antibiotics in addition to benzathine penicillin C in HIV-infected patients with primary or secondary syphilis, HIV-infected patients with early latent syphilis should be treated with the recommended regimen for latent syphilis of more than I -year s duration. 

PeniciUinase-resistant penicillins (such as dicloxadllin) are the agents of first choice because of the increased isolation of S. aureus. First-generation cephalosporins (such as cephalexin) are also effective (see Table 47-3). Penicillin may be used for impetigo caused by S. pyogenes. It may be administered as either a single intramuscular dose of benzathine penicillin G (300,000 to 600,000 units in children, 1.2 million units in adults) or as oral penicillin VK given for 7 to 10 days. PenidUin-allergic patients can be treated with oral clindamycin. 

In contrast to hypersensitivity, other adverse reactions do not require sensitization and require similar doses of drug for recurrence. A special case is a syndrome (Hoigne s syndrome) that resembles an immediate allergic reaction combined with hallucinations, aggressive behavior, anxiety, and auditory and visual disturbances, which has been described after intramuscular procaine penicUhn and benzathine penicillin. It is probably due to accidental intravascular injection and results from micro-embohsm of the penicUhn depot formulation (271-275). 

Although impetigo may resolve spontaneously, antimicrobial treatment is indicated to relieve symptoms, prevent formation of new lesions, and prevent complications, such as cellulitis. PeniciUinase-resistant penicillins (dicloxacUlin 12.5 mg/kg orally daily in fom divided doses for children) are preferred for treatment because of the increased incidence of infections caused by S. aureus. First-generation cephalosporins are also effective, although they are generally more expensive. Cephalexin (25-50 mg/kg orally daily in two divided doses for children) and cefadroxU (30 mg/kg oraUy daily in two divided doses for children) are used commonly. Penicillin, administered as either a single intramuscular dose of benzathine penicillin G (300,000-... 

Table 115-6 presents the CDC s treatment recommendations. Parenteral penicillin G is the treatment of choice for all stages of syphihs. Because T. pallidum multiplies slowly, single doses of short- or intermediate-acting penicillins do not provide the prolonged, low-level exposure to penicillin required for eradication of the treponeme. As a result, benzathine penicillin G is the only penicillin effective for single-dose therapy. " ... 

Patients with abnormal CSF findings should be treated as having neurosyphilis. Preferred regimens for neurosyphilis provide treatment over 10 to 14 days with parenteral penicillin G administered every 4 hours. Benzathine penicillin G alone in standard weekly doses and procaine penicillin G in doses under 2.4 million units do not consis-... 

Most are eliminated via active tubular secretion with half-life <60 min. Dose reduction needed only in major renal dysfunction. Nafcillin and oxacillin eliminated largely in bile ampicillin undergoes enterohepatic cycling, but is excreted by the kidney. Benzathine penicillin G—repository form (half-life of 2 weeks). 

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