Penicillin G Procaine

DEA Class; Rx

Common Brand Names; Wycillin

Indicated for moderately severe uncomplicated pneumococcal pneumonia

Indicated for moderately severe-to-severe tonsillitis, erysipelas, scarlet fever, upper respiratory tract, skin and soft tissue infections

Indicated only for treatment of extremely sensitive infections; not indicated for prophylaxis

Also indicated in Syphilis, Anthrax, Diphtheria, Vincent’s Infection (fusospirochetosis), Erysipeloid

Indicated for Streptobacillus moniliformis and Spirillum minus (rat-bite fever)

Indicated for susceptible microorganisms that respond to low and persistent penicillin G serum levels (if high, sustained serum levels required, use aqueous penicillin G IV/IM)

Streptococci Groups A, C, G, H, L, and M are sensitive (Group D, ie, enterococcus is resistant); aqueous penicillin G recommended for streptococcal bacteremia

Moderate/severe respiratory tracts infection caused by pneumococci (use aqueous penicillin G for acute stage of severe pneumonia, empyema, bacteremia, pericarditis, meningitis, peritonitis, or arthritis)

Moderate/severe skin infections caused by susceptible staphylococci

Susceptible fusiform bacilli and spirochetes (fusospirochetosis)

Syphilis (all stages) caused by susceptible Treponema pallidum

Yaws, Bejel, Pinta

C diphtheriae carrier stage

Anthrax

Rat-bite fever caused by Streptobacillus moniliformis and Spirillum minus

Erysipeloid caused by Erysipelothrix rhusiopathiae

Subacute bacterial endocarditis, only in extremely sensitive infections caused by susceptible Group A streptococci

Hypersensitivity to drug or excipients

Skin rashes including maculopapular eruptions and exfoliative dermatitis

Urticaria

Serum-sicknesslike reactions (eg, chills, fever, edema, arthralgia, prostration)

Jarisch-Herxheimer reaction reported when treating syphilis

Pseudomembranous colitis

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

No longer indicated for gonorrhea; should not be used for beta-lactamase producing organisms which include most strains of Neisseria gonorrhea

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

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 in patients taking penicillin G (the active moiety in penicillin G procaine); when SCAR suspected, discontinue therapy immediately and consider alternative treatment

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

Penicillin should be used with caution in individuals with histories of significant allergies and/or asthma

Care should be taken to avoid intravenous or intra-arterial administration, or injection into or near major peripheral nerves or blood vessels, since such injections may produce neurovascular damage

A small percentage of patients are sensitive to procaine; if there is a history of sensitivity, make the usual test: inject intradermally 0.1 mL of a 1 to 2 percent procaine solution; development of erythema, wheal, flare, or eruption indicates procaine sensitivity; sensitivity should be treated by usual methods, including barbiturates, and the procaine penicillin preparations not used; antihistaminics appear beneficial in treatment of procaine reactions

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

Whenever allergic reactions occur, penicillin should be withdrawn unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to penicillin therapy

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

Penicillins are excreted in human milk; exercise caution when penicillins are administered to a nursing woman

2.4 million units/day IM.

2.4 million units/day IM.

50,000 units/kg/day IM up to 2.4 million units/day IM..

50,000 units/kg/day IM up to 2.4 million units/day IM.

50,000 units/kg/day IM.

50,000 units/kg/day IM.