The Hip: Preservation, Replacement and Revision

Penicillin G Aqueous


- See: Penicillin Family

- DOC for Group A strep, pneumococcus, N. gonorrhea, syphilis;
- good for most Gm positive, Streptococcus, Meningitis, Clostridium, Cornybacterium, coliforms,
- prophylaxis for bacterial endocarditis;
   - Adult: 250-500 mg (400-800 K units) PO qid;
   - IV 1.2-24 million units per day;
- Strep Pneumonia: 1-2 million units IV q4-6hr;
* Not for Rx of osteomyelitis
    - 2 million U IV - after 30-60 min -
    - Mean Ser. conc (ug/ml) = 0.5 to 9.4 / M.Bone. conc: undetectable
* IM is painful; Note hypersensitivity;
- Good diffusion from blood into CSF only with inflammation;
   -  Note: Ratio of CSF to Blood Level (%): Normal Meninges: <1;
   -  Inflammed Meninges: 3-5;
- Dosing Regimens for Patients w/ Renal Insufficiency:
   (Dose for 70 kg Adult {gm/dosing interval in hours}): CrCl:>80:3MU/4; CrCl:50-79:2MU/4; CrCl:30-49:1.5MU/4; CrCl:10-29:1MU/4-6;
  - 80% of drug will be excreted in to urine (w/ nl RF(x))
- Convulsions and Hallucinations w/ high doses in renal failure;
- Peds: <12 yrs: 100,000-300,000 units/kg/24hr IM, or IV in 4-6 DD or 25-50 mg/kg/day PO divided q6hr;
--------------------------------
The transcapillary passage and interstitial fluid concentration of penicillin in canine bone.
-----------------------------------------------
Penicillin G Benzathine/Bicillin: LA Bicillin
- for single dose Rx for Strep pharyngitis, rhuematic fever, and glomerulonephritis prophylaxis;
- Adult:1.2 - 2.4 million units deep IM q 2-4 weeks;
- DOC for non-congenital syphilis; Bicillin LA has only benzathine;
- Bicillin CR has benzathine and procaine, and CR is used for most Strep infections (300k units procaine and 300k units benzathine/ml, or 900k units/or 900k units benzathine & 300 k units Procaine/2ml;
- Dosage forms: 300,000 & 600,000 Units/ml for IM administration;
- Good diffusion from blood into CSF only with inflammation;
- Note Diffusion from Blood into CSF is NIL even w/ Inflammation;
- Peds: 25k-50,000 units/kg/dose to max of 2.4 million units/dose q2-4 weeks;
-----------------------------------------
Penicillin G Procaine/Bicillin CR, Wycillin:
- Dosage form:300,000 & 500k & 600,000 Units/ml for IM administration;
- Good diffusion from blood into CSF only with inflammation;
- Convulsions and Hallucinations w/ high doses in renal failure;
- Bicillin CR has benzathine and procaine, and CR is used for most Strep infections (300k units procaine and 300k units benzathine/ml, or 900k units benzathine & 300 k units Procaine/2ml;
- Peds: 25,000-50,000 units/kg/day IM divided qd/bid;
       or 0.1 ml/kg/ IM dose x1 w/ 300k/300k
       or 0.5 ml/kg/ IM dose x1
- Procaine PCN G
 - Peds dosing:
   - 300,000 units/1 ml: pneumonia 25,000 u/kg IM dose q 12-24 hr;
   - 600,000 units/1.2 ml: GC  units, which is preceded by probenicid 25 mg/kg/PO dose
Penicillin G Sodium:
- dosage form: 5,000,000 Units/vial for IV administration;
- Good diffusion from blood into CSF only with inflammation;
- Convulsions and Hallucinations w/ high doses in renal failure;
- cholestyramine will decrease absorption of Pen Gand that Beta blockers will increase anaphylaxis
Penicillin G Potassium/Pentids:
- dosage forms: 200,000 & 250k & 400,000 Units/5ml (Reconstituted susp/syrup) for PO administration;
- Alternative dosage forms:100,000 200k  250k  400k  500k  800,000 Units for PO administration: (Tab 250mg==400,000 Units);
- Other dosage forms: 200,000  500k,  1,000k 5,000k  10,000k  20,000k Units for IM/IV administration but w/ greater than 5,000,000 Units use IV only



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 6, 2012 4:17 pm