Penicillin G Procaine

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General

  • Type: Natural Penicillin
  • Routes of Administration: IM
  • Common Trade Names:

Adult Dosing

Anthrax

  • Inhalational (Postexposure Prophylaxis)
    • 1,200,000 units IM q12 hours x 60 days (see below)
    • Info: Total treatment duration = 60 days. Do not give IM for over 2 weeks, switching alternative treatment to complete course
  • Cutaneous, Nonsevere (Treatment)
    • 600,000-1,200,000 units/day IM

Endocarditis by susceptible Streptococcus viridans

Neurosyphilis

  • 2.4 million units/day IM + 500mg probenecid PO QID x 10-14 days
  • Info: Penicillin G aqueous I.V. is preferred

Whipple's Disease

Pediatric Dosing

Avoid use in neonates: increased risk of sterile abscesses and procaine reactions

General

  • 25,000-50,000 units/kg/day divided 1-2 times/day
  • First Dose: 25,000-50,000 units/kg x 1
  • Max: 4.8 million units/day

Anthrax

  • Inhalational (postexposure prophylaxis)
    • 25,000 units/kg IM q12 hours
    • Max: 1,200,000 units q12 hours
    • Info: Total treatment duration = 60 days. Do not give IM for over 2 weeks, switching alternative treatment to complete course

Syphilis (Congenital)

  • 50,000 units/kg/day IM daily x 10 days
  • If >1 day of therapy is missed, restart entire course of treatment

Special Populations

  • Pregnancy Category: B
  • Lactation: Use caution
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug
  • Avoid use in neonates

Adverse Reactions

Serious

  • Procaine reactions: Immediate toxic reactions, particularly when a large single dose is administered (4.8 million units); mental disturbances including anxiety, confusion, agitation, depression, weakness, seizures, hallucinations, combativeness, and fear
  • Jarisch-Herxheimer reaction with syphilis treatment
  • Pseudomembranous colitis

Common

  • Rash, urticaria, exfoliative dermatitis
  • Serum-sickness like reaction

Pharmacology

  • Half-life: 30m
  • Metabolism: Hepatic
  • Excretion: Urinary
  • Mechanism of Action: Bactericidal; Interferes with cell wall mucopeptide synthesis during active multiplication

See Also

References