II. Indications
- Scarlet Fever
- Group A Streptococcal Soft Tissue Infection
- Pneumococcal Pneumonia
III. Contraindications
IV. ` Penicillin or Procaine Allergy
- Do NOT inject intravenously (potentially lethal)
- Do NOT use for Syphilis (use Bicillin LA instead)
- Do NOT use for Meningitis (use Penicillin G instead or broader spectrum antibiotics)
- Avoid for Streptococcal Pharyngitis (use Bicillin LA instead)
V. Mechanism
- See Penicillin
- Semisynthetic, long-acting benzathine salt of Penicillin G
- See Natural Penicillin for activity spectrum
- Bicillin LA is typically preferred instead of Bicillin CR (based on activity curves)
VI. Dosing
-
General
- Inject deep IM into upper outer buttock, or in children, inject into the mid-lateral thigh
-
Scarlet Fever or Group A Streptococcal Soft Tissue Infection
- Adult: Give 2.4 Million Units IM for 1 dose
- Child
- Weight <13.6 Kg: 600,000 units IM for 1 dose
- Weight 13.6 to 27 kg: 900,000 to 1.2 Million Units IM for 1 dose
- Weight >27 kg: 2.4 Million Units IM for 1 dose
-
Pneumococcal Pneumonia
- Adult: Give 1.2 Million Units IM every 2 to 3 days until affebrile for 48 hours
- Child: Give 600,000 Units IM every 2 to 3 days until affebrile for 48 hours
VII. Adverse Effects
- See Penicillin
VIII. Safety
- Considered safe in pregnancy
- Considered safe in Lactation
IX. Resources
- Procaine Penicillin and Benzathine Penicillin (DailyMed)
X. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 104-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Bush (2016) Cold Spring Harb Perspect Med 6(8):a025247 +PMID: 27329032 [PubMed]
- Miller (2002) J Midwifery Womens Health 47(6):426-34 +PMID: 12484664 [PubMed]