II. Indications: Penicillin Sensitive Infections (culture-based)
- Pneumococcal Pneumonia
- Pneumococcal Meningitis
- Streptococcal Native Valve Endocarditis
- Group B Streptococcal Meningitis
- Neurosyphilis or Ocular Syphilis
- Congenital Syphilis
- Anthrax
- Diphtheria
III. Contraindications
IV. Mechanism
- See Penicillin
- First Penicillin to be used medically
- See Natural Penicillin for activity spectrum
V. Precautions
- Dose adjustments needed in renal dysfunction
VI. Dosing: Adults
- See Anthrax
-
Pneumococcal Pneumonia (Penicillin Sensitive)
- Give 8 to 12 million units IV every 4 to 6 hours
- Pneumococcal Meningitis (Penicillin Sensitive)
- Give 24 million units IV every 4 to 6 hours
- Streptococcal Native Valve Endocarditis (Streptococcal gallolyticus or viridans, with MIC<= 0.12 mcg/ml)
- Give 12 to 18 million units IV every 4 hours for 4 weeks (may use continuous infusion)
-
Neurosyphilis or Ocular Syphilis
- Give 18 to 24 million units IV every 4 hours for 10 to 14 days (may use continuous infusion)
-
Diphtheria (not FDA approved)
- Give 100,000 to 150,000 units/kg/day IV divided every 6 hours for 14 days
-
Group B Streptococcus Prophylaxis (in GBS positive mothers)
- Start 5 Million Units IV at labor onset or Rupture of Membranes
- Next 2.5 to 3 Million Units IV every 4 hours until delivery
VII. Dosing: Child
- See Anthrax
- Mild to Moderate Infections
- Give 25,000 to 50,000 units/kg/day IV every 6 hours
- Severe Infections (e.g. Pneumococcal Pneumonia or Meningitis)
- Child: Give 250,000 to 400,000 units/kg/day IV divided every 4 to 6 hours
- Newborn: 25,000 to 50,000 units/kg IV every 8 hours
- When age >1 week and weight >2 kg, increase dosing frequency to every 6 hours
- Group B Streptococcal Meningitis
- Age <1 week: Give 250,000 to 400,000 units/kg/day IV divided every 8 hours
- Age >1 week: Give 450,000 to 500,000 units/kg/day IV divided every 4 to 6 hours
-
Congenital Syphilis
- Newborn (<1 month): 50,000 units/kg/dose IV every 12 hours for 10 days
- When age >1 week, increase dosing frequency to every 8 hours
- Child (age >1 month): 50,000 units/kg/dose IV every 4 to 6 hours for 10 days
- Newborn (<1 month): 50,000 units/kg/dose IV every 12 hours for 10 days
-
Diphtheria (not FDA approved)
- Give 100,000 to 150,000 units/kg/day IV divided every 6 hours for 14 days
VIII. Adverse Effects
- See Penicillin
IX. Safety
- Considered safe in pregnancy
- Considered safe in Lactation
X. Resources
- Penicillin G (DailyMed)
XI. 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]