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Penicillin G (intravenous and short-acting intramuscular): Pediatric drug information

Penicillin G (intravenous and short-acting intramuscular): Pediatric drug information
(For additional information see "Penicillin G (intravenous and short-acting intramuscular): Drug information" and see "Penicillin G (intravenous and short-acting intramuscular): Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Pfizerpen
Therapeutic Category
  • Antibiotic, Penicillin
Dosing: Neonatal

Note: International considerations: Dosages are expressed in international units; 1 million units is equal to approximately 600 mg (Ref). International product labeling may express strength and dosing in mg instead of units.

General dosing, susceptible infection (non-CNS) (Ref): IV, IM:

Gestational Age

Postnatal Age

Dose

≤34 weeks

≤7 days

50,000 units/kg/dose every 12 hours

8 to 28 days

50,000 units/kg/dose every 8 hours

>34 weeks

≤7 days

50,000 units/kg/dose every 12 hours

8 to 28 days

50,000 units/kg/dose every 8 hours

Anthrax, systemic; treatment

Anthrax, systemic (including meningitis); treatment:

Note: Consult public health officials for event-specific recommendations. Use as part of an appropriate combination regimen for ≥14 days if meningitis is excluded or ≥14 to 21 days if meningitis cannot be excluded, and until patient clinically stable. May transition to oral step-down therapy when clinically appropriate to complete course if meningitis has been excluded. Treatment should be followed by prophylaxis for a total antibiotic course of 60 days (Ref).

IV:

Gestational Age

Postnatal Age

Dose

32 to 34 weeks

≤7 days

100,000 units/kg/dose every 12 hours

8 to 28 days

100,000 units/kg/dose every 8 hours

>34 weeks

≤7 days

100,000 units/kg/dose every 8 hours

8 to 28 days

100,000 units/kg/dose every 6 hours

Group B Streptococcus sepsis

Group B Streptococcus sepsis (non-meningitis):

Preterm and term neonates:

PNA ≤7 days: IV: 50,000 units/kg/dose every 12 hours for 10 days (Ref).

PNA 8 to 28 days: IV: 50,000 units/kg/dose every 8 hours for 10 days (Ref).

PNA 29 to 60 days: IV: 50,000 units/kg/dose every 6 hours for 10 days (Ref).

Meningitis, including Group B streptococcal

Meningitis, including Group B streptococcal (GBS): Note: Duration of therapy dependent upon pathogen and clinical response; in general, durations are as follows: GBS (uncomplicated courses): 14 days, GBS ventriculitis: ≥4 weeks, Listeria: ≥21 days; longer durations may be necessary for prolonged or complicated courses (Ref).

AAP dosing (Ref): Preterm and term neonates:

PNA ≤7 days: IV, IM: 150,000 units/kg/dose every 8 hours.

PNA 8 to 60 days: IV, IM: 125,000 units/kg/dose every 6 hours.

IDSA dosing (Ref): Neonates ≥2 kg:

PNA ≤7 days: IV: 150,000 units/kg/day in divided doses every 8 to 12 hours.

PNA 8 to 28 days: IV: 200,000 units/kg/day in divided doses every 6 to 8 hours.

Syphilis, congenital

Syphilis, congenital (with or without CNS involvement): Note: If >1 day of therapy is missed, the entire course needs to be restarted (Ref).

Preterm and term neonates:

PNA ≤7 days: IV: 50,000 units/kg/dose every 12 hours; at PNA 8 days, increase to 50,000 units/kg/dose every 8 hours for a total of 10 days (Ref).

PNA 8 to 28 days: IV: 50,000 units/kg/dose every 8 hours for a total of 10 days (Ref).

PNA 29 to 60 days:

Preterm neonates: IV: 50,000 units/kg/dose every 6 hours for a total of 10 days (Ref).

Term neonates: IV: 50,000 units/kg/dose every 4 to 6 hours for a total of 10 days (Ref).

Dosing: Pediatric

Note: International considerations: Dosages are expressed in international units; 1 million units is equal to approximately 600 mg (Ref). International product labeling may express strength and dosing in mg instead of units.

General dosing, susceptible infection (non-CNS): Infants, Children, and Adolescents: IM, IV: 100,000 to 300,000 units/kg/day in divided doses every 4 to 6 hours; maximum daily dose: 24 million units/day (Ref).

Anthrax, systemic; treatment

Anthrax, systemic (including meningitis); treatment: Note: Consult public health officials for event-specific recommendations.

Infants, Children, and Adolescents: IV: 400,000 units/kg/day in divided doses every 4 hours; maximum dose: 4 million units/dose. Use as part of an appropriate combination regimen for ≥14 days if meningitis is excluded or ≥14 to 21 days if meningitis cannot be excluded, and until patient clinically stable. Note: May transition to oral step-down therapy when clinically appropriate to complete course if meningitis has been excluded. Treatment must be followed by prophylaxis for a total antibiotic course of 60 days (Ref).

Diphtheria

Diphtheria: Infants, Children, and Adolescents: IM, IV: 150,000 to 250,000 units/kg/day in divided doses every 6 hours for 7 to 10 days (Ref). AAP suggests a duration of 14 days (Ref).

Endocarditis, bacterial; treatment

Endocarditis, bacterial; treatment: Children and Adolescents: IV: 200,000 to 300,000 units/kg/day in divided doses every 4 hours; maximum daily dose: 24 million units/day; treat for ≥4 weeks; longer durations may be necessary; may use in combination with gentamicin for some resistant organisms (Ref). Note: For endocarditis from rat-bite fever/haverhill fever, the manufacturer recommends a lower dose of 150,000 to 250,000 units/kg/day in divided doses every 4 hours; maximum daily dose: 20 million units/day.

Lyme disease

Lyme disease (Borrelia spp. infection) (alternative agent): Infants, Children, and Adolescents: IV: 200,000 to 400,000 units/kg/day in divided doses every 4 hours; maximum daily dose: 24 million units/day. Duration of therapy depends on clinical syndrome; treat meningitis or radiculopathy for 14 to 21 days (Ref).

Meningitis, including health care-associated ventriculitis/meningitis

Meningitis, including health care-associated ventriculitis/meningitis: Infants, Children, and Adolescents: IV: 300,000 to 400,000 units/kg/day divided every 4 to 6 hours; maximum dose: 4 million units/dose; maximum daily dose: 24 million units/day (Ref).

Pneumonia, community-acquired

Pneumonia, community-acquired (CAP):

Infants >3 months and Children:

Empiric treatment or S. pneumoniae (moderate to severe; MICs to penicillin ≤2 mcg/mL): IV: 200,000 to 250,000 units/kg/day divided every 4 to 6 hours (Ref).

Group A Streptococcus (moderate to severe): IV: 100,000 to 250,000 units/kg/day divided every 4 to 6 hours (Ref).

Skin and soft tissue infection

Skin and soft tissue infection (Streptococcal infection or necrotizing infections due to Clostridium or Streptococcus species):

Infants, Children, and Adolescents: IV: 60,000 to 100,000 units/kg/dose every 6 hours; maximum dose: 4 million units/dose; adult dose: 2 to 4 million units every 4 to 6 hours. For necrotizing infections, use in combination with clindamycin and continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (Ref).

Syphilis

Syphilis:

Congenital: Infants and Children: IV: 50,000 units/kg/dose every 4 to 6 hours for 10 days (Ref).

Neurosyphilis (including ocular syphilis):

Infants and Children: IV: 50,000 units/kg/dose every 4 to 6 hours for 10 to 14 days; maximum daily dose: 24 million units/day (Ref).

Adolescents: IV: 3 to 4 million units every 4 hours or as a continuous infusion for 10 to 14 days; maximum daily dose: 24 million units/day (Ref).

Tetanus, treatment

Tetanus, treatment: Infants, Children, and Adolescents: IV: 100,000 units/kg/day in divided doses every 6 hours in combination with tetanus immune globulin; maximum daily dose: 20 million units/day (Ref). Continue penicillin for 7 to 10 days (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Infants, Children, and Adolescents: IM, IV:

Uremic patients with CrCl >10 mL/minute/1.73 m2: Administer a normal dose followed by 50% of the normal dose every 4 to 5 hours.

CrCl <10 mL/minute/1.73 m2: Administer a normal dose followed by 50% of the normal dose every 8 to 10 hours.

Hemodialysis: Dialyzable.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, the manufacturer's labeling recommends further adjustment of doses adjusted for renal impairment in patients with both renal and hepatic impairment.

Dosing: Adult

(For additional information see "Penicillin G (intravenous and short-acting intramuscular): Drug information")

Note: For ease of outpatient administration, the total daily dose may be administered as a 24-hour continuous infusion (Ref).

International considerations : Dosages below are expressed as international units; 1 million units is equal to approximately 600 mg (Ref). International product labeling may express strength and dosing in mg instead of units.

Actinomycosis, severe or extensive

Actinomycosis, severe or extensive: IV: 10 to 20 million units/day as a continuous infusion or in divided doses every 4 to 6 hours for 4 to 6 weeks followed by appropriate long-term oral therapy (Ref).

Bloodstream infection

Bloodstream infection:

Pathogen-directed therapy for Enterococcus spp. (off-label use): IV: 18 to 30 million units/day as a continuous infusion or in divided doses every 4 hours; use as part of an appropriate combination regimen in the setting of suspected endocarditis or critical illness (Ref). Duration of therapy is 7 to 14 days for uncomplicated infection (ie, fever resolution within 72 hours and absence of metastatic focus of infection or endovascular hardware) (Ref). Some experts recommend a duration of 5 to 7 days for uncomplicated infection if blood cultures clear within 24 hours (Ref).

Pathogen-directed therapy for Listeria monocytogenes: IV: 24 million units/day in divided doses every 4 hours; use in combination with gentamicin for nonpregnant patients. Duration should be individualized based on patient factors, source and extent of infection, and clinical response. Penicillin is usually continued for at least 2 weeks; patients who are immunocompromised warrant a longer course (eg, at least 3 to 6 weeks) (Ref).

Pathogen directed therapy for beta-hemolytic streptococci: IV: 18 to 24 million units/day in divided doses every 4 hours. Duration of therapy is generally 14 days; some experts suggest a shorter course (eg, 10 days) for patients with rapid clearance of bacteremia and clinical improvement (Ref).

Pathogen-directed therapy for group D streptococci (Streptococcus bovis/Streptococcus equinus complex) (alternative agent): IV: 12 to 24 million units/day in divided doses every 4 hours. Duration of therapy is 14 days in the absence of other clinical manifestations (Ref).

Botulism, wound

Note: The role of systemic antimicrobials is uncertain in the absence of local signs of infection (Ref).

Botulism, wound (adjunctive agent following antitoxin administration): IV: 18 to 20 million units/day in divided doses every 4 to 6 hours in combination with wound debridement; duration depends on extent of the wound (Ref).

Diphtheria

Diphtheria (adjunctive agent following antitoxin administration) (alternative agent): IV: 2 to 3 million units/day in divided doses every 4 to 6 hours for 10 to 12 days (Ref).

Endocarditis, treatment

Endocarditis, treatment:

Enterococcus, native or prosthetic valve (penicillin-susceptible/gentamicin-susceptible) (off-label use): IV: 18 to 30 million units/day as a continuous infusion or in divided doses every 4 hours in combination with an aminoglycoside (eg, gentamicin). Duration is usually 6 weeks; for patients with native valve endocarditis and symptoms <3 months, antibiotic therapy may be given for 4 weeks. Note: Reserve this regimen for patients with CrCl >50 mL/minute (Ref). For native-valve endocarditis due to ampicillin-susceptible Enterococcus faecalis, some experts prefer a different beta-lactam combination regimen (Ref).

Viridans group streptococci and Streptococcus gallolyticus (S. bovis):

Native valve: Highly penicillin-susceptible (minimum inhibitory concentration [MIC] ≤0.12 mcg/mL): IV: 12 to 18 million units/day as a continuous infusion or in divided doses every 4 or 6 hours for 4 weeks; for patients with uncomplicated infection, rapid response to therapy, and no underlying disease, an alternative is 12 to 18 million units/day as a continuous infusion or in divided doses every 4 hours in combination with gentamicin for 2 weeks (Ref).

Native valve: Relatively penicillin-resistant (MIC >0.12 to <0.5 mcg/mL): IV: 24 million units/day as a continuous infusion or in divided doses every 4 or 6 hours for 4 weeks in combination with gentamicin for the first 2 weeks (Ref).

Native valve: Penicillin-resistant (MIC ≥0.5 mcg/mL): IV: 18 to 30 million units/day as a continuous infusion or in divided doses every 4 or 6 hours in combination with gentamicin. The duration of this regimen is not well established; infectious diseases consultation recommended (Ref).

Prosthetic valve: Highly penicillin-susceptible (MIC ≤0.12 mcg/mL): IV: 24 million units/day as a continuous infusion or in divided doses every 4 or 6 hours for 6 weeks (with or without concomitant gentamicin for the first 2 weeks) (Ref). Some experts prefer giving in combination with gentamicin for all patients without contraindications (Ref).

Prosthetic valve: Relatively or fully penicillin-resistant (MIC >0.12 mcg/mL): IV: 24 million units/day as a continuous infusion or in divided doses every 4 or 6 hours in combination with gentamicin for 6 weeks (Ref). For relatively resistant strains, some experts prefer a shorter duration of the gentamicin component (≥2 weeks) (Ref).

Leptospirosis, severe

Leptospirosis, severe (off-label use): IV: 1.5 million units every 6 hours for 7 days (Ref).

Lyme disease

Lyme disease (Borrelia spp. infection) (alternative agent) (off-label use):

Carditis, severe disease (patients who are symptomatic, have second- or third-degree atrioventricular block, or have first-degree atrioventricular block with PR interval ≥300 msec): IV: 18 to 24 million units/day in divided doses every 4 hours until high-grade atrioventricular block resolved and PR interval <300 msec; may switch to oral therapy to complete a total of 14 to 21 days (Ref).

Acute neurologic disease (eg, meningitis, radiculopathy), patients requiring hospitalization: IV: 18 to 24 million units/day in divided doses every 4 hours for 14 to 21 days (Ref).

Late neurologic disease: IV: 18 to 24 million units/day in divided doses every 4 hours for 14 to 28 days (Ref); some experts favor a duration of 28 days (Ref).

Recurrent arthritis after adequate oral regimen: IV: 18 to 24 million units/day in divided doses every 4 hours for 14 days; may extend to 28 days if inflammation is not resolving (Ref).

Meningitis, bacterial

Meningitis, bacterial:

Pathogen-directed therapy for Cutibacterium acnes, L. monocytogenes, Neisseria meningitidis (with MIC <0.1 mcg/mL), Streptococcus agalactiae, or Streptococcus pneumoniae (with MIC ≤0.06 mcg/mL): IV: 4 million units every 4 hours (Ref). For treatment of L. monocytogenes, use as part of an appropriate combination regimen (Ref). Treatment duration is 7 to 21 days, depending on causative pathogen(s) and clinical response (Ref).

Neurosyphilis

Neurosyphilis (including ocular and otosyphilis ): Note: Penicillin desensitization and treatment is recommended in patients with a history of severe penicillin allergy (Ref).

IV: 18 to 24 million units/day as a continuous infusion or in divided doses every 4 hours for 10 to 14 days. For late neurosyphilis (syphilis exposure >1 year ago), may consider administration of penicillin G benzathine following initial IV penicillin G aqueous therapy to provide a comparable total duration of therapy for late syphilis (Ref).

Odontogenic soft tissue infection, pyogenic

Odontogenic soft tissue infection, pyogenic (alternative agent): IV: 2 to 4 million units every 4 to 6 hours in combination with metronidazole; following clinical improvement, transition to oral step-down therapy and continue antibiotics until resolution, typically for a total of 7 to 14 days (Ref).

Osteomyelitis and/or discitis

Osteomyelitis and/or discitis (off-label use):

Pathogen-directed therapy for C. acnes, Enterococcus spp. (penicillin-susceptible), or beta-hemolytic streptococci: IV: 20 to 24 million units/day as a continuous infusion or in divided doses every 4 hours, generally for ≥6 weeks depending on patient-specific factors such as organism, extent of infection, debridement, and clinical response. Shorter courses are appropriate if the affected bone is completely resected (eg, by amputation) (Ref).

Prosthetic joint infection

Prosthetic joint infection (off-label use):

Pathogen-directed therapy for C. acnes, Enterococcus spp. (penicillin-susceptible), or Streptococcus spp.: IV: 20 to 24 million units/day as a continuous infusion or in divided doses every 4 hours (Ref). Duration varies but is generally 4 to 6 weeks depending on patient-specific factors, infection site, and intervention (Ref). Note: For enterococcal infections, the addition of an aminoglycoside is optional (Ref), but some experts prefer other regimens in the setting of retained hardware unless an aminoglycoside-impregnated implant is present, in which case beta-lactam monotherapy is likely sufficient (Ref).

Rat bite fever

Rat bite fever:

Uncomplicated infection: IV: 200,000 units every 4 hours; if patient clinically improves, may switch to an oral antibiotic after 5 to 7 days to complete a 14-day course (Ref).

Serious invasive infection (including bacteremia, meningitis, endocarditis, and other focal organ involvement): IV: 12 to 18 million units/day as a continuous infusion or in divided doses every 4 to 6 hours; may increase dose to 24 million units/day in patients with an isolate that is not highly penicillin-susceptible (eg, MIC >0.1 mcg/mL) or in patients with prosthetic valve endocarditis. Duration depends on site of infection and extent of disease (eg, 4 weeks for endocarditis) (Ref).

Skin and soft tissue infection, streptococcal

Skin and soft tissue infection, streptococcal (group A Streptococcus, beta-hemolytic streptococci) (off-label use):

Erysipelas: IV: 2 to 4 million units every 4 to 6 hours. Total duration of therapy is ≥5 days (including oral step-down therapy); may extend to 14 days depending on severity and clinical response (Ref). Note: Some experts favor other regimens unless a streptococcal- or penicillin-susceptible infection has been microbiologically confirmed (Ref).

Necrotizing soft tissue infection: Note: Use in conjunction with early and aggressive surgical exploration and debridement of necrotic tissue.

IV: 4 million units every 4 hours in combination with clindamycin. Once the patient is clinically and hemodynamically stable for 48 to 72 hours, can give penicillin monotherapy. Total duration is individualized and depends on need for further debridement and patient clinical status (Ref).

Streptococcus, maternal prophylaxis for prevention of neonatal disease

Streptococcus (group B), maternal prophylaxis for prevention of neonatal disease (off-label use): IV: 5 million units as a single dose at onset of labor or prelabor rupture of membranes, then 2.5 to 3 million units every 4 hours until delivery (Ref).

Tetanus

Tetanus (Clostridium tetani infection) (adjunctive agent following tetanus immune globulin and vaccine administration) (alternative agent): IV: 2 to 4 million units every 4 to 6 hours for 7 to 10 days (Ref).

Toxic shock syndrome, streptococcal

Toxic shock syndrome, streptococcal: IV: 4 million units every 4 hours in combination with clindamycin. Duration of therapy depends on extent and severity of infection and response to treatment; treat patients who are bacteremic for ≥14 days (Ref).

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Reduced kidney function may increase the risk of penicillin G accumulation, and monitoring for evidence of toxicity (eg, neurotoxicity) is recommended (manufacturer's labeling).

Altered kidney function:

Note: Recommendations are expert opinion derived from Bryan 1975 and Komatsu 2016.

CrCl >50 mL/minute: IV: No dosage adjustment necessary.

CrCl >30 to 50 mL/minute: IV: Administer 50% to 75% of the usual indication-specific dose as a continuous infusion or in divided doses every 4 to 6 hours.

CrCl 10 to 30 mL/minute: IV: Administer 25% to 50% of the usual indication-specific dose as a continuous infusion or in divided doses every 4 to 6 hours.

CrCl <10 mL/minute: IV: Administer 20% to 25% of the usual indication-specific dose as a continuous infusion or in divided doses every 4 to 6 hours.

Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m2):

Note: Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Younger patients (<55 years of age) admitted post trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).

IV: Use of the indication-specific maximum dose is recommended; administer via continuous infusion, if feasible (Ref).

Hemodialysis, intermittent (thrice weekly): Likely to be significantly dialyzable (Ref).

IV: Administer 100% of the usual indication-specific dose for the first dose, then administer 25% to 50% of the usual indication-specific dose as a continuous infusion or in divided doses every 4 to 6 hours thereafter (Ref).

Peritoneal dialysis: Likely to be dialyzed:

IV: Dose as for CrCl <10 mL/minute (Ref).

CRRT:

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) and minimal residual kidney function unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.

IV: Administer 100% of the usual indication-specific dose for the first dose, then administer 50% to 75% of the usual indication-specific dose as a continuous infusion or in divided doses every 4 to 6 hours (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration):

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.

PIRRT days: IV: Administer 100% of the usual indication-specific dose for the first dose, then administer 50% to 75% of the usual indication-specific dose as a continuous infusion or in divided doses every 4 to 6 hours (Ref).

Non-PIRRT days: IV: Dose as for CrCl <10 mL/minute (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, the manufacturer's labeling recommends further adjustment of doses adjusted for renal impairment in patients with both renal and hepatic impairment.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Local thrombophlebitis, localized phlebitis

Central nervous system: Coma (high doses), hyperreflexia (high doses), myoclonus (high doses), seizure (high doses)

Dermatologic: Exfoliative dermatitis, maculopapular rash, skin rash

Endocrine & metabolic: Electrolyte disorder (high doses)

Gastrointestinal: Clostridioides difficile associated diarrhea, Clostridioides difficile colitis

Hematologic & oncologic: Neutropenia, positive direct Coombs test (rare, high doses)

Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reaction (immediate and delayed), serum sickness-like reaction

Immunologic: Jarisch-Herxheimer reaction

Local: Pain at injection site

Renal: Acute interstitial nephritis (high doses), renal tubular disease (high doses)

Contraindications

Hypersensitivity to any penicillin or any component of the formulation

Documentation of allergenic cross-reactivity for beta-lactams (eg, penicillins and cephalosporins) is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactic/hypersensitivity reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy, especially with a history of beta-lactam hypersensitivity (including cephalosporins) or history of sensitivity to multiple allergens. Use with caution in asthmatic patients. If a serious reaction occurs, discontinue treatment and institute supportive measures.

• Neurovascular damage: Avoid intra-arterial administration or injection into or near major peripheral nerves or blood vessels since such injections may cause severe and/or permanent neurovascular damage.

• Severe cutaneous adverse reactions: Severe cutaneous adverse reactions (SCAR) (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis) have been reported; discontinue immediately if SCAR is suspected.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended. In the presence of concomitant hepatic impairment, further dosage adjustment may be needed.

• Seizure disorders: Use with caution in patients with a history of seizure disorder; high levels, particularly in the presence of renal impairment, may increase risk of seizures.

Special populations:

• Neonates: Neonates may have decreased renal clearance of penicillin and require frequent dosage adjustments depending on age.

Other warnings/precautions:

• Electrolyte imbalance: Product contains sodium and potassium; high doses of IV therapy may alter serum levels. If high doses (eg, >10 million units) are used, administer at a slower rate (eg, >30 minutes for intermittent IV infusion).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as potassium [preservative free]:

Generic: 20,000 units/mL (50 mL); 40,000 units/mL (50 mL); 60,000 units/mL (50 mL)

Solution Reconstituted, Injection, as potassium [preservative free]:

Pfizerpen: 5,000,000 units (1 ea); 20,000,000 units (1 ea)

Pfizerpen: 5,000,000 units (1 ea); 20,000,000 units (1 ea) [pyrogen free]

Generic: 5,000,000 units (1 ea); 20,000,000 units (1 ea)

Solution Reconstituted, Injection, as sodium [preservative free]:

Generic: 5,000,000 units (1 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (reconstituted) (Penicillin G Potassium Injection)

5000000 unit (per each): $5.23 - $42.18

20000000 unit (per each): $59.99 - $160.26

Solution (reconstituted) (Penicillin G Sodium Injection)

5000000 unit (per each): $57.60

Solution (reconstituted) (Pfizerpen Injection)

5000000 unit (per each): $15.26

20000000 unit (per each): $61.06

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Injection:

Generic: 1,000,000 units (1 ea); 10,000,000 units (1 ea)

Solution Reconstituted, Injection, as sodium:

Generic: 5,000,000 units (1 ea)

Additional Information

Penicillin G potassium: 1.7 mEq of potassium and 0.3 mEq of sodium per 1 million units of penicillin G

Penicillin G sodium: 2 mEq of sodium per 1 million units of penicillin G

Administration: Pediatric

Parenteral:

IM: Administer IM by deep injection in the upper outer quadrant of the buttock. Administer injection around-the-clock to promote less variation in peak and trough levels.

IV: Usually administered by intermittent infusion. In some centers, large doses may be administered by continuous IV infusion. The potassium or sodium content of the dose should be considered when determining the infusion rate.

Intermittent IV: Infuse over 15 to 30 minutes

Continuous IV infusion: Daily dose may be administered as a continuous infusion over 24 hours, or smaller increments (eg, 24 hour dose divided into two 12-hour infusions)

Administration: Adult

IM: Administer IM by deep injection in the upper outer quadrant of the buttock. Administer injection around-the-clock to promote less variation in peak and trough levels.

IV: Usually administered by intermittent infusion. In some centers, large doses may be administered by continuous IV infusion. Note: The 20 million unit dosage form may be administered by IV infusion only.

Intermittent IV: Infuse over 15 to 30 minutes.

Storage/Stability

Penicillin G potassium powder for injection should be stored below 86°F (30°C). Following reconstitution, solution may be stored for up to 7 days under refrigeration. Premixed bags for infusion should be stored at -20°C or -4°F; frozen bags may be thawed at 25°C (77°F) or in a refrigerator (5°C [41°F]). Once thawed, solution is stable for 14 days at 5°C (41°F) or for 24 hours at 25°C (77°F). Do not refreeze once thawed.

Penicillin G sodium powder for injection should be stored at 20°C to 25°C (68°F to 87°F). Once reconstituted, the manufacturer recommends refrigeration (2°C to 8°C [36°F to 46°F]) and use within 3 days of reconstitution. After further dilution to 2,500 to 50,000 units/mL in either D5W or NS (in PVC bags or elastomeric pump containers), one study demonstrated stability when stored under refrigeration for up to 21 days (Hossain 2014).

Use

Treatment of infections (including sepsis, empyema, pneumonia, pericarditis, endocarditis, meningitis, anthrax, botulism, gas gangrene, and tetanus) caused by susceptible organisms; active against some gram-positive organisms, generally not Staphylococcus aureus; some gram-negative organisms such as Neisseria gonorrhoeae and some anaerobes and spirochetes (FDA approved in all ages).

Medication Safety Issues
Sound-alike/look-alike issues:

Penicillin may be confused with penicillamine

Penicillin G (parenteral/aqueous) may be confused with penicillin G benzathine, penicillin G procaine, penicillin V potassium

Metabolism/Transport Effects

Substrate of OAT1/3

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acemetacin: May increase the serum concentration of Penicillins. Risk C: Monitor therapy

Aminoglycosides: Penicillins may decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Risk C: Monitor therapy

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Dichlorphenamide: Penicillins may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy

Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Methotrexate: Penicillins may increase the serum concentration of Methotrexate. Risk C: Monitor therapy

Mycophenolate: Penicillins may decrease serum concentrations of the active metabolite(s) of Mycophenolate. This effect appears to be the result of impaired enterohepatic recirculation. Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Penicillins. Risk C: Monitor therapy

Sodium Benzoate: Penicillins may diminish the therapeutic effect of Sodium Benzoate. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Tetracyclines: May diminish the therapeutic effect of Penicillins. Risk C: Monitor therapy

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Penicillins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Dietary Considerations

Some products may contain potassium and/or sodium.

Pregnancy Considerations

Penicillin G crosses the placenta.

In a study of women administered IV penicillin G (parenteral/aqueous) for group B streptococcal (GBS) disease, peak fetal concentrations occurred within 1 hour (Barber 2008).

Penicillin is widely used in pregnant women. Based on available data, penicillin is generally considered compatible for use during pregnancy (Ailes 2016; Bookstaver 2015; Crider 2009; Damkier 2019; Erić 2012; Heinonen 1977; Lamont 2014; Muanda 2017a; Muanda 2017b).

Maternal penicillin G serum concentrations are not decreased in obese patients following IV administration for GBS prophylaxis; however, cord blood concentrations may be less. Based on available data, minimum inhibitory concentrations for GBS are still achieved (McCoy 2020). Penicillin G (parenteral/aqueous) is the drug of choice for intrapartum prophylaxis to prevent neonatal GBS early onset disease. Untreated asymptomatic GBS disease can result in maternal urinary tract infection, intraamniotic infection, endometritis, preterm labor, and/or stillbirth. Vertical transmission from the mother can cause sepsis, pneumonia, or meningitis in the newborn. Treatment is intended to prevent early-onset disease in newborns. Prophylaxis is reserved for pregnant patients with a positive GBS vaginal or rectal screening in late gestation, GBS bacteriuria during the current pregnancy, history of birth of an infant with early-onset GBS disease, and unknown GBS culture status with any of the following: birth <37 0/7 weeks gestation, intrapartum fever, prolonged rupture of membranes, known GBS positive in a previous pregnancy, or intrapartum nucleic acid amplification testing positive for GBS (ACOG 2020).

Penicillin G is the drug of choice for treatment of syphilis during pregnancy (CDC [Workowski 2021]). Untreated maternal syphilis can cause congenital syphilis which is associated with bone deformities, neurologic impairment, stillbirth, or neonatal death (USPSTF 2018). Symptoms of congenital syphilis may include hepatosplenomegaly, jaundice, nonimmune hydrops, pseudoparalysis of an extremity, rhinitis, or skin rash. The CDC Sexually Transmitted Diseases Treatment Guidelines provide recommendations for the treatment of syphilis in pregnant patients. The penicillin regimen (dose, duration, and preparation) for the treatment of pregnant patients is the same as for a nonpregnant patient and depends on the stage of syphilis. Parenteral penicillin G is the only agent with documented efficacy in pregnancy. Patients who are allergic to penicillin should be desensitized and treated with penicillin. Pregnant patients being treated for latent syphilis must repeat the full course of therapy if any doses are missed. A Jarisch-Herxheimer reaction may occur in any patient within the first 24 hours of therapy, including pregnant patients. This reaction may induce early labor, fetal distress, or stillbirth (rare); however, it is not a reason to prevent or delay maternal therapy (CDC [Workowski 2021]).

Maternal infection with Bacillus anthracis may cause preterm labor, fetal infection, fetal distress, or fetal loss. Maternal death may also occur. When IV therapy is required for anthrax infection in pregnant and postpartum patients, penicillin G may be used as an alternative agent. The dose and duration of antibiotic therapy in pregnant and postpartum patients is the same as in nonpregnant adults. Adjustments in dose for pregnancy are not recommended until additional pharmacokinetic data becomes available (Meaney-Delman 2014).

Monitoring Parameters

Periodic serum electrolytes, renal and hematologic function tests, cardiac and hematologic function tests during prolonged/high-dose therapy; observe for signs and symptoms of anaphylaxis during first dose and changes in bowel frequency.

Mechanism of Action

Interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Poor penetration across blood-brain barrier, despite inflamed meninges

Relative diffusion from blood into CSF: Poor unless meninges inflamed (exceeds usual MICs)

CSF:blood level ratio: Inflamed meninges: 2% to 6%

Half-life elimination:

Neonates: <6 days of age: 3.1 hours; ≥14 days of age: 1.4 hours

Adults: Normal renal function: 31 to 50 minutes

End-stage renal disease (ESRD): 6 to 20 hours (Aronoff 2007)

Time to peak, serum: IV: Immediately after infusion

Excretion: Urine (58% to 85% as unchanged drug)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Excretion is delayed.

Hepatic function impairment: When combined with impaired renal function, elimination is further delayed.

Older adult: Renal clearance may be delayed (caused by decreased renal function).

Anti-infective considerations:

Parameters associated with efficacy:

Time dependent, associated with time free drug concentration (fT) > minimum inhibitory concentration (MIC), goal: ≥50% fT > MIC (bactericidal) (Craig 1996; Craig 1998).

Expected drug exposure in adults with normal renal function:

5 million units over 3 to 5 minutes (single dose): 400 mg/L (5 to 6 minutes postinfusion); 273 mg/L (10 minutes postinfusion); 3 mg/L (4 hours postinfusion).

Postantibiotic effect: Minimal bacterial killing continues after penicillin concentration falls below the MIC of targeted pathogen and varies based on the organism:

Gram-positive cocci: 1.5 to 3.5 hours (Craig 1991; Garcia 1995; Zhanel 1991).

Gram-negative bacilli: 0 to 1.5 hours (Craig 1991; Zhanel 1991).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (BD) Bangladesh: G-penicillin b;
  • (BG) Bulgaria: Penicillin | Penicillin crystallisate tzf;
  • (BR) Brazil: Benzecilin | Benzilpenicilina potassica | Cristacilina | Cristalpen | Megapacilina | Megapen | Pen-syn | Pencil p | Penicilina g procaina;
  • (CN) China: Benzylpenicillin k | Benzylpenicillin-k;
  • (CZ) Czech Republic: Penicillin g;
  • (EE) Estonia: Pen g potassium;
  • (FI) Finland: Penadur l a;
  • (GR) Greece: Penicilline g;
  • (HU) Hungary: Penicillin;
  • (IN) India: Benzylpenicillin;
  • (IT) Italy: Benzil p Bha | Penicillina g potassica;
  • (JP) Japan: Penicillin g potassium asahi kasei | Penicillin g potassium banyu | Penicillin g potassium fujisawa | Penicillin g potassium meiji seika | Penicillin g potassium takeda;
  • (KR) Korea, Republic of: Penicillin g potassium | Penmix penicillin g potassium;
  • (LB) Lebanon: Penicillin g;
  • (LT) Lithuania: Penicillin | Penicillin g | Penicillina k;
  • (LV) Latvia: Penicillin-g;
  • (PH) Philippines: Penicillin | Penicillin g potassium;
  • (PK) Pakistan: Benzyl penicillin | Benzylpenicillin;
  • (PL) Poland: Penicillinum crystallisatum;
  • (PR) Puerto Rico: Penicillin g | Penicillin g potassium | Pfizerpen G;
  • (PT) Portugal: Penicilina atral | Penicilina g potassica;
  • (RU) Russian Federation: Penicillin;
  • (SK) Slovakia: Penicillin g;
  • (TH) Thailand: Penicillin g;
  • (TR) Turkey: Kristapen | Pencrist | Penicilline g | Pensilina;
  • (TW) Taiwan: K-cillin;
  • (UA) Ukraine: Penicillin | Penicillin g;
  • (VE) Venezuela, Bolivarian Republic of: Penicilina
  1. Ailes EC, Gilboa SM, Gill SK, et al; The National Birth Defects Prevention Study. Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011. Birth Defects Res A Clin Mol Teratol. 2016;106(11):940-949. doi:10.1002/bdra.23570 [PubMed 27891788]
  2. American Academy of Pediatrics (AAP). In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021.
  3. American College of Obstetricians and Gynecologists (ACOG). Prevention of group B streptococcal early-onset disease in newborns: ACOG committee opinion, number 797. Obstet Gynecol. 2020;135(2):e51‐e72. doi:10.1097/AOG.0000000000003668 [PubMed 31977795]
  4. Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, PA: American College of Physicians; 2007.
  5. Baddour LM, Chen AF. Prosthetic joint infection: Treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 16, 2022.
  6. Baddour LM, Wilson WR, Bayer AS, et al; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132(15):1435-1486. doi:10.1161/CIR.0000000000000296 [PubMed 26373316]
  7. Baltimore RS, Gewitz M, Baddour LM, et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young and the Council on Cardiovascular and Stroke Nursing. Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation. 2015;132(15):1487-1515. doi:10.1161/CIR.0000000000000298 [PubMed 26373317]
  8. Barber EL, Zhao G, Buhimschi IA, Illuzzi JL. Duration of intrapartum prophylaxis and concentration of penicillin G in fetal serum at delivery. Obstet Gynecol. 2008;112(2 Pt 1):265-270. doi:10.1097/AOG.0b013e31817d0246 [PubMed 18669721]
  9. Barshak MB, Madoff LC. Group B streptococcal infections in nonpregnant adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 25, 2022.
  10. Berbari EF, Kanj SS, Kowalski TJ, et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26-e46. doi:10.1093/cid/civ482 [PubMed 26229122]
  11. Bilbao-Meseguer I, Rodríguez-Gascón A, Barrasa H, Isla A, Solinís MÁ. Augmented renal clearance in critically ill patients: a systematic review. Clin Pharmacokinet. 2018;57(9):1107-1121. doi:10.1007/s40262-018-0636-7 [PubMed 29441476]
  12. Bonnetblanc JM, Bédane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003;4(3):157-163. [PubMed 12627991]
  13. Bookstaver PB, Bland CM, Griffin B, Stover KR, Eiland LS, McLaughlin M. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015;35(11):1052-1062. doi:10.1002/phar.1649 [PubMed 26598097]
  14. Bradley JS, Byington CL, Shah SS, et al. The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-76. [PubMed 21880587]
  15. Bradley JS, Nelson JD, eds. Nelson's Pediatric Antimicrobial Therapy. 25th ed. Itasca, IL: American Academy of Pediatrics; 2019.
  16. Bradley JS, Nelson JD, Kimberlin DK, et al, eds. Nelson's Pocket Book of Pediatric Antimicrobial Therapy. 28th ed. American Academy of Pediatrics; 2022.
  17. Bradley JS, Peacock G, Krug SE, et al; AAP Committee on Infectious Diseases and Disaster Preparedness Advisory Council. Pediatric anthrax clinical management. Pediatrics. 2014;133(5):e1411-1436. doi:10.1542/peds.2014-0563 [PubMed 24777226]
  18. Brook I. Actinomycosis: diagnosis and management. South Med J. 2008;101(10):1019-1023. doi:10.1097/SMJ.0b013e3181864c1f [PubMed 18791528]
  19. Brook I. Treatment of actinomycosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 20, 2020.
  20. Bryan CS, Stone WJ. "Comparably massive" penicillin G therapy in renal failure. Ann Intern Med. 1975;82(2):189-195. doi:10.7326/0003-4819-82-2-189
  21. Centers for Disease Control and Prevention (CDC). Fatal rat-bite fever--Florida and Washington, 2003. MMWR Morb Mortal Wkly Rep. 2005;53(51):1198-1202. [PubMed 15635289]
  22. Chow AW. Complications, diagnosis, and treatment of odontogenic infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 9, 2022.
  23. Chu VH. Antimicrobial therapy of left-sided native valve endocarditis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 24, 2020.
  24. Craig WA. Antimicrobial resistance issues of the future. Diagn Microbiol Infect Dis. 1996;25(4):213-217. doi:10.1016/s0732-8893(96)00162-9 [PubMed 8937847]
  25. Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis. 1998;26(1):1-10. doi:10.1086/516284 [PubMed 9455502]
  26. Craig WA. The postantibiotic effect. Clin Microbiol Newsletter. 1991;13(16):121-124. doi:10.1016/0196-4399(91)90030-Y
  27. Crider KS, Cleves MA, Reefhuis J, Berry RJ, Hobbs CA, Hu DJ. Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study. Arch Pediatr Adolesc Med. 2009;163(11):978-985. doi:10.1001/archpediatrics.2009.188 [PubMed 19884587]
  28. Damkier P, Brønniche LMS, Korch-Frandsen JFB, Broe A. In utero exposure to antibiotics and risk of congenital malformations: a population-based study. Am J Obstet Gynecol. 2019;221(6):648.e1-648.e15. doi:10.1016/j.ajog.2019.06.050 [PubMed 31260651]
  29. Donowitz GR and Mandell GL, “Beta-Lactam Antibiotics,” N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500. [PubMed 3277054]
  30. Drevets DA, Canono BP, Leenen PJ, et al. Gentamicin kills intracellular Listeria monocytogenes. Infect Immun. 1994;62(6):2222-2228. [PubMed 8188344]
  31. Elliott SP. Rat bite fever and Streptobacillus moniliformis. Clin Microbiol Rev. 2007;20(1):13-22. doi:10.1128/CMR.00016-06 [PubMed 17223620]
  32. Erić M, Leppée M, Sabo A, Culig J. Beta-lactam antibiotics during pregnancy: a cross-sectional comparative study Zagreb-Novi Sad. Eur Rev Med Pharmacol Sci. 2012;16(1):103-110. [PubMed 22338555]
  33. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  34. Garcia LB, Benchetrit LC, Barrucand L. Penicillin post-antibiotic effects on the biology of group A streptococci. J Antimicrob Chemother. 1995;36(3):475-482. doi:10.1093/jac/36.3.475 [PubMed 8830011]
  35. Gelfand MS. Treatment, prognosis, and prevention of Listeria monocytogenes infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 20, 2020.
  36. Gilbert DN, Moellering RC, Eliopoulos GM, et al, eds, The Sanford Guide To Antimicrobial Therapy, 2006, 36th ed, Hyde Park, VT: Antimicrobial Therapy, Inc, 2006, 6-7.
  37. Greene HJ, Burkhart B, Hobby GL. Excretion of penicillin in human milk following parturition. Am J Obstet Gyn. 1946;51:732-733. [PubMed 21025164]
  38. Halperin JJ. Nervous system Lyme disease: diagnosis and treatment. Curr Treat Options Neurol. 2013;15(4):454-464. [PubMed 23666548]
  39. Halperin JJ, Shapiro ED, Logigian E, et al; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69(1):91-102. [PubMed 17522387]
  40. Hansen JM, Kampmann J, and Laursen H, “Renal Excretion of Drugs in the Elderly,” Lancet, 1970, 1(657):1170.
  41. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Publishing Sciences Group, Inc. 1977.
  42. Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. Pharmacotherapy. 2009;29(5):562-577. doi:10.1592/phco.29.5.562 [PubMed 19397464]
  43. High KP, Bradley SF, Gravenstein S, et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(2):149-171. [PubMed 19072244]
  44. Hoen B. Infections due to group D streptococci (Streptococcus bovis/Streptococcus equinus complex). Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 20, 2020.
  45. Hof H, Nichterlein T, Kretschmar M. Management of listeriosis. Clin Microbiol Rev. 1997;10(2):345-357. [PubMed 9105758]
  46. Hossain MA, Friciu M, Aubin S, Leclair G. Stability of penicillin G sodium diluted with 0.9% sodium chloride injection or 5% dextrose injection and stored in polyvinyl chloride bag containers and elastomeric pump containers. Am J Health Syst Pharm. 2014;71(8):669-673. [PubMed 24688042]
  47. Hu L. Treatment of Lyme disease. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 29, 2021.
  48. Humphrey JH, Musset MV, Perry WL. The second international standard for penicillin. Bull World Health Organ. 1953;9(1):15-28. [PubMed 13082387]
  49. Karchmer AW, Chu VH. Antimicrobial therapy of prosthetic valve endocarditis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 24, 2020.
  50. King KY. Rat bite fever. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 27, 2022.
  51. Komatsu T, Inomata T, Watanabe I, et al. Population pharmacokinetic analysis and dosing regimen optimization of penicillin G in patients with infective endocarditis. J Pharm Health Care Sci. 2016;2:9. doi:10.1186/s40780-016-0043-x [PubMed 27051524]
  52. Lamont HF, Blogg HJ, Lamont RF. Safety of antimicrobial treatment during pregnancy: a current review of resistance, immunomodulation and teratogenicity. Expert Opin Drug Saf. 2014;13(12):1569-1581. doi:10.1517/14740338.2014.939580 [PubMed 25189188]
  53. Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis, and treatment of lyme disease. Arthritis Care Res (Hoboken). 2021;73(1):1-9. doi:10.1002/acr.24495 [PubMed 33251700]
  54. Leikola E, Vartia KO. On Penicillin Levels in Young and Geriatric Subjects. J Gerontol. 1957;12:48-52. [PubMed 13398605]
  55. Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl 2):S27-S72. [PubMed 17278083]
  56. Matsuda S. Transfer of antibiotics into maternal milk. Biol Res Pregnancy Perinatol. 1984;5(2):57-60. [PubMed 6743732]
  57. McCoy JA, Elovitz MA, Alby K, Koelper NC, Nissim I, Levine LD. Association of obesity with maternal and cord blood penicillin levels in women with group B Streptococcus colonization. Obstet Gynecol. 2020;136(4):756-764. doi:10.1097/AOG.0000000000004020 [PubMed 32925625]
  58. Meaney-Delman D, Zotti ME, Creanga AA, et al. Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. Emerg Infect Dis. 2014;20(2). [PubMed 24457117]
  59. Medoff G, Kunz LJ, Weinberg AN. Listeriosis in humans: an evaluation. J Infect Dis. 1971;123(3):247-250. [PubMed 5000073]
  60. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45. doi:10.1086/599376 [PubMed 19489710]
  61. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Resp Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST [PubMed 31573350]
  62. Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and the risk of major congenital malformations: a population based cohort study. Br J Clin Pharmacol. 2017a;83(11):2557-2571. doi:10.1111/bcp.13364 [PubMed 28722171]
  63. Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ. 2017b;189(17):E625-E633. doi:10.1503/cmaj.161020 [PubMed 28461374]
  64. Murray BE, Miller WR. Treatment of enterococcal infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 20, 2020.
  65. Nau H. Clinical pharmacokinetics in pregnancy and perinatology. II. Penicillins. Dev Pharmacol Ther. 1987;10(3):174-198. doi:10.1159/000457744 [PubMed 3301235]
  66. Nishimura RA, Otto CM, Bonow RO, et al, 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-92. doi:10.1161/CIR.0000000000000029 [PubMed 24589852]
  67. Osmon DR, Berbari EF, Berendt AR, et al; Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1-e25. doi:10.1093/cid/cis803 [PubMed 23223583]
  68. Osmon DR, Tande AJ. Osteomyelitis in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 20, 2020.
  69. Panaphut T, Domrongkitchaiporn S, Vibhagool A, Thinkamrop B, Susaengrat W. Ceftriaxone compared with sodium penicillin g for treatment of severe leptospirosis. Clin Infect Dis. 2003;36(12):1507-1513. [PubMed 12802748]
  70. Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed July 26, 2019.
  71. Pegram PS, Stone SM. Botulism. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 1, 2023.
  72. Penicillin G Potassium Injection [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; November 2017.
  73. Penicillin G potassium injection [prescribing information]. Princeton, NJ: Sandoz GmbH; September 2020.
  74. Penicillin G sodium for injection (penicillin G [parenteral/aqueous]) [prescribing information]. Princeton, NJ: Sandoz Inc; May 2020.
  75. Pfizerpen (penicillin G potassium) [prescribing information]. New York, NY: Roerig; December 2022.
  76. Pfizerpen (penicillin G potassium) [prescribing information]. New York, NY: Roerig; July 2022.
  77. Prober CG, Stevenson DK, and Benitz WE, “The Use of Antibiotics in Neonates Weighing Less Than 1200 Grams,” Pediatr Infect Dis J, 1990, 9(2):111-21. [PubMed 2179837]
  78. Puopolo KM, Lynfield R, Cummings JJ; Committee on Fetus and Newborn; Committee on Infectious Diseases. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019;144(2):e20191881. doi:10.1542/peds.2019-1881 [PubMed 31285392]
  79. Quagliarello VJ, Scheld WM. Treatment of Bacterial Meningitis. N Engl J Med. 1997;336(10):708-716. [PubMed 9041103]
  80. Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical guidelines for diagnosis and treatment of botulism, 2021. MMWR Recomm Rep. 2021;70(2):1-30. doi:10.15585/mmwr.rr7002a1 [PubMed 33956777]
  81. Refer to manufacturer's labeling.
  82. Robinson DC, Cookson TL, Grisafe JA. Concentration guidelines for parenteral antibiotics in fluid-restricted patients. Drug Intell Clin Pharm. 1987;21(12):985-989. [PubMed 3428165]
  83. Roughgarden JW. Antimicrobial therapy of ratbite fever. A review. Arch Intern Med. 1965;116:39-54. doi:10.1001/archinte.1965.03870010041007 [PubMed 14338952]
  84. Sanchez E, Vannier E, Wormser GP, Hu LT. Diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: a review. JAMA. 2016;315(16):1767-1777. doi:10.1001/jama.2016.2884 [PubMed 27115378]
  85. Schliamser SE, Cars O, Norrby SR. Neurotoxicity of beta-lactam antibiotics: predisposing factors and pathogenesis. J Antimicrob Chemother. 1991;27(4):405-425. [PubMed 1856121]
  86. Schrag S, Gorwitz R, Fultz-Butts K, et al, “Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC,” MMWR, Recomm Rep, 51(RR11):1-22. [PubMed 12211284]
  87. Sexton DJ, Thwaites L. Tetanus. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 20, 2020.
  88. Spelman D, Baddour LM. Acute cellulitis and erysipelas in adults: Treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 17, 2022.
  89. Stevens DL. Invasive group A streptococcal infection and toxic shock syndrome: treatment and prevention. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed July 21, 2021.
  90. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):147-159. doi:10.1093/cid/ciu296 [PubMed 24947530]
  91. Suputtamongkol Y, Niwattayakul K, Suttinont C, et al. An open, randomized, controlled trial of penicillin, doxycycline, and cefotaxime for patients with severe leptospirosis. Clin Infect Dis. 2004;39(10):1417-1424. [PubMed 15546074]
  92. Trotman RL, Williamson JC, Shoemaker DM, Salzer WL. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. Clin Infect Dis. 2005;41(8):1159-1166. [PubMed 16163635]
  93. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267-1284. doi:10.1086/425368 [PubMed 15494903]
  94. Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34-e65. doi:10.1093/cid/ciw861 [PubMed 28203777]
  95. Udy AA, Roberts JA, Boots RJ, Paterson DL, Lipman J. Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet. 2010;49(1):1-16. doi:10.2165/11318140-000000000-00000 [PubMed 20000886]
  96. US Preventive Services Task Force (USPSTF), Curry SJ, Krist AH, et al. Screening for syphilis infection in pregnant women: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2018;320(9):911-917. [PubMed 30193283]
  97. Walker MJ, Barnett TC, McArthur JD, et al. Disease manifestations and pathogenic mechanisms of group A Streptococcus. Clin Microbiol Rev. 2014;27(2):264-301. doi:10.1128/CMR.00101-13 [PubMed 24696436]
  98. Walton AL, Howden BP, Grayson LM, Korman TM. Continuous-infusion penicillin home-based therapy for serious infections due to penicillin-susceptible pathogens. Int J Antimicrob Agents. 2007;29(5):544-548. doi:10.1016/j.ijantimicag.2006.10.018 [PubMed 17398076]
  99. Watt G, Padre LP, Tuazon ML. Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. Lancet.1988;1(8583):433-435. [PubMed 2893865]
  100. Wessels MR. Group C and group G streptococcal infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 20, 2020.
  101. Wickerts CJ, Asaba H, Gunnarsson B, et al. Combined Carbon Haemoperfusion and Haemodialysis in the Treatment of Penicillin Intoxication. Br Med J. 1980;280(6226):1254-1255.
  102. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 [PubMed 34292926]
  103. World Health Organization; International Leptospirosis Society. Human leptospirosis: guidance for diagnosis surveillance and control. http://apps.who.int/iris/bitstream/10665/42667/1/WHO_CDS_CSR_EPH_2002.23.pdf. Published 2003. Accessed August 17, 2016.
  104. World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the eleventh WHO model list of essential drugs. 2002. http://www.who.int/maternal_child_adolescent/documents/55732/en/
  105. Wright AJ. The Penicillins. Mayo Clin Proc. 1999;74(3):290-307. [PubMed 10090000]
  106. Yoshikawa TT. Antimicrobial Therapy for the Elderly Patient. J Am Geriatr Soc. 1990;38(12):1353-1372. [PubMed 2254575]
  107. Zhanel GG, Hoban DJ, Harding GK. The postantibiotic effect: a review of in vitro and in vivo data. DICP. 1991;25(2):153-163. doi:10.1177/106002809102500210 [PubMed 2058187]
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