Penicillin G Benzathine/Penicillin G Procaine

DEA Class; Rx

Common Brand Names; Bicillin C-R, Bicillin C-R 900/300

Indicated for moderately severe-to-severe infections of upper-respiratory tract, scarlet fever, erysipelas, and skin and soft-tissue infections caused by streptococcal Group A

Indicated for Pneumococcal Infections

NOT for pneumococcal meningitis

Hypersensitivity; serious and occasionally fatal reactions have been reported

For deep IM administration only; do not administer IV, SC, or IT

Severe cutaneous adverse reactions (SCAR), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) reported; discontinue therapy when SCAR suspected; consider an alternative treatment

Procaine reactions: Immediate toxic reactions to procaine reported, particularly when a large single dose is administered (4.8 million units); reaction manifested by mental disturbances including anxiety, confusion, agitation, depression, weakness, seizures, hallucinations, combativeness, and fear

Avoid use in neonates; increased risk for sterile abscess development and procaine toxicity

Severe pneumonia, empyema, bacteremia, pericarditis, meningitis, peritonitis, and arthritis of pneumococcal etiology are better treated with penicillin G sodium or potassium during the acute stage

When high, sustained serum levels are required, penicillin G sodium or potassium, either IM or IV, should be used

NOT indicated for treatment of venereal diseases, including syphilis, gonorrhea, yaws, bejel, and pinta

Only prescribe combination of penicillin G benzathine and penicillin G procaine for the approved indications

Prescribing in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases the risk of a development of drug-resistant bacteria

For deep intramuscular injection only; there have been reports of inadvertent intravenous administration of penicillin G benzathine which has been associated with cardiorespiratory arrest and death; therefore, do not inject intravenously or admix with other intravenous solutions

Administer intramuscularly only in the upper, outer quadrant of the buttock (dorsogluteal) or ventrogluteal site; quadriceps femoris fibrosis and atrophy reported following repeated intramuscular injections of penicillin preparations into anterolateral thigh; therefore, administration in anterolateral thigh not recommended

In prolonged therapy with penicillin, and particularly with high-dosage schedules, periodic evaluation of renal and hematopoietic systems is recommended

The use of antibiotics may result in overgrowth of nonsusceptible organisms; constant observation of patient is essential; if new infections due to bacteria or fungi appear during therapy, the drug should be discontinued and appropriate measures taken.

Reproduction studies performed in the mouse, rat, and rabbit have revealed no evidence of impaired fertility or harm to fetus due to penicillin G

Soluble penicillin G is excreted in breast milk; exercise caution when penicillin G benzathine and penicillin G procaine are administered to a nursing woman