Penicillin G Benzathine / Procaine Penicillin Dosage

Medically reviewed by Drugs.com. Last updated on Jun 1, 2023.

Usual Adult Dose for Skin or Soft Tissue Infection

Bicillin C-R: 2,400,000 units IM once

Comments:

• The recommended dose is generally administered at 1 session using multiple IM sites (as indicated).
• An alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.

Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci

Usual Adult Dose for Upper Respiratory Tract Infection

Bicillin C-R: 2,400,000 units IM once

Comments:

• The recommended dose is generally administered at 1 session using multiple IM sites (as indicated).
• An alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.

Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci

Usual Adult Dose for Streptococcal Infection

Bicillin C-R: 2,400,000 units IM once

Comments:

• The recommended dose is generally administered at 1 session using multiple IM sites (as indicated).
• An alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.

Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci

Usual Adult Dose for Otitis Media

Bicillin C-R: 1,200,000 units IM repeated every 2 or 3 days
Duration of therapy: Until temperature is normal for 48 hours

Comments:

• Other forms of penicillin may be needed for severe cases.

Uses: For the treatment of moderately severe pneumonia and otitis media due to susceptible Streptococcus pneumoniae; for pneumococcal infections (except pneumococcal meningitis)

Usual Adult Dose for Pneumonia

Bicillin C-R: 1,200,000 units IM repeated every 2 or 3 days
Duration of therapy: Until temperature is normal for 48 hours

Comments:

• Other forms of penicillin may be needed for severe cases.

Uses: For the treatment of moderately severe pneumonia and otitis media due to susceptible Streptococcus pneumoniae; for pneumococcal infections (except pneumococcal meningitis)

Usual Pediatric Dose for Skin or Soft Tissue Infection

Bicillin C-R:

• Weight less than 13.6 kg: 600,000 units IM once
• Weight 13.6 to 27.3 kg: 900,000 to 1,200,000 units IM once
• Weight 27.3 kg or more: 2,400,000 units IM once

Bicillin C-R 900/300: 1,200,000 units IM once

Comments:

• Bicillin C-R: The recommended dose is generally administered at 1 session using multiple IM sites (as indicated); an alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
• Bicillin C-R 900/300: A single injection is usually sufficient.

Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci

American Academy of Pediatrics Recommendations:
Bicillin C-R:
1 month or older:

• Weight less than 14 kg: 600,000 units IM once
• Weight 14 to 27 kg: 1,200,000 units IM once
• Weight 27 kg or more: 2,400,000 units IM once

Comments:

• Major use is the treatment of group A streptococcal infections
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Upper Respiratory Tract Infection

Bicillin C-R:

• Weight less than 13.6 kg: 600,000 units IM once
• Weight 13.6 to 27.3 kg: 900,000 to 1,200,000 units IM once
• Weight 27.3 kg or more: 2,400,000 units IM once

Bicillin C-R 900/300: 1,200,000 units IM once

Comments:

• Bicillin C-R: The recommended dose is generally administered at 1 session using multiple IM sites (as indicated); an alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
• Bicillin C-R 900/300: A single injection is usually sufficient.

Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci

American Academy of Pediatrics Recommendations:
Bicillin C-R:
1 month or older:

• Weight less than 14 kg: 600,000 units IM once
• Weight 14 to 27 kg: 1,200,000 units IM once
• Weight 27 kg or more: 2,400,000 units IM once

Comments:

• Major use is the treatment of group A streptococcal infections
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Streptococcal Infection

Bicillin C-R:

• Weight less than 13.6 kg: 600,000 units IM once
• Weight 13.6 to 27.3 kg: 900,000 to 1,200,000 units IM once
• Weight 27.3 kg or more: 2,400,000 units IM once

Bicillin C-R 900/300: 1,200,000 units IM once

Comments:

• Bicillin C-R: The recommended dose is generally administered at 1 session using multiple IM sites (as indicated); an alternative regimen (one-half the total dose on days 1 and 3) may be used, but only when the patient's cooperation can be assured.
• Bicillin C-R 900/300: A single injection is usually sufficient.

Uses: For the treatment of moderately severe to severe upper respiratory tract infections, scarlet fever, erysipelas, and skin and soft tissue infections due to susceptible group A streptococci

American Academy of Pediatrics Recommendations:
Bicillin C-R:
1 month or older:

• Weight less than 14 kg: 600,000 units IM once
• Weight 14 to 27 kg: 1,200,000 units IM once
• Weight 27 kg or more: 2,400,000 units IM once

Comments:

• Major use is the treatment of group A streptococcal infections
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Otitis Media

Bicillin C-R: 600,000 units IM repeated every 2 or 3 days
Bicillin C-R 900/300: 1,200,000 units IM repeated every 2 or 3 days

Duration of therapy: Until temperature is normal for 48 hours

Comments:

• Other forms of penicillin may be needed for severe cases.

Uses: For the treatment of moderately severe pneumonia and otitis media due to susceptible S pneumoniae; for pneumococcal infections (except pneumococcal meningitis)

Usual Pediatric Dose for Pneumonia

Bicillin C-R: 600,000 units IM repeated every 2 or 3 days
Bicillin C-R 900/300: 1,200,000 units IM repeated every 2 or 3 days

Duration of therapy: Until temperature is normal for 48 hours

Comments:

• Other forms of penicillin may be needed for severe cases.

Uses: For the treatment of moderately severe pneumonia and otitis media due to susceptible S pneumoniae; for pneumococcal infections (except pneumococcal meningitis)

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNING:

• ADMINISTRATION: This drug is not for IV use; it must not be injected IV or admixed with other IV solutions. Inadvertent IV administration of penicillin G benzathine has been associated with cardiorespiratory arrest and death. The manufacturer product information should be consulted before administering this drug.

CONTRAINDICATIONS:
Previous hypersensitivity reaction to any penicillin or to procaine

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• For IM injection only; do not inject into or near an artery or nerve; do not inject IV or admix with other IV solutions.
• Administer by deep IM injection in the upper, outer quadrant of the buttock (dorsogluteal) or the ventrogluteal site; may prefer the midlateral aspect of the thigh in neonates, infants, and small children
• The needle may be blocked if the drug is not injected at a slow, steady rate (due to high concentration of suspended material in product).
• Rotate the injection site when doses are repeated.
• Do not use this drug for severe infections (e.g., severe pneumonia, empyema, bacteremia [including streptococcal infections with bacteremia], pericarditis, meningitis, peritonitis, pneumococcal arthritis) during the acute stage or when high, sustained serum drug levels are required; use IM or IV penicillin G sodium/potassium instead.
• Do not use this drug in the treatment of venereal diseases (including syphilis, gonorrhea, yaws, bejel, pinta).

Storage requirements:

• Store in refrigerator between 2C to 8C (36F to 46F); keep from freezing.

General:

• This drug should only be used for indications listed in the manufacturer product information; this drug is for the treatment of moderately severe infections due to penicillin-G-sensitive microorganisms susceptible to serum levels typical of this formulation (lower but more prolonged than other parenteral penicillins).
• Bacteriological studies (including susceptibility testing) and clinical response should guide therapy.
• Groups A, C, G, H, L, and M streptococci are very susceptible to penicillin G; other groups (including group D [enterococci]) are resistant.
• In streptococcal infections, therapy should be sufficient to eradicate the organism, otherwise streptococcal disease sequelae may occur; cultures should be taken after completion of therapy to verify streptococci have been eliminated.
• Culture and susceptibility information should be considered when selecting/modifying antibacterial therapy or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.
• Bicillin C-R: Each 2 mL syringe contains the equivalent of 1,200,000 units of penicillin G with 600,000 units of penicillin G as the benzathine salt and 600,000 units of penicillin G as the procaine salt.
• Bicillin C-R 900/300: Each 2 mL syringe contains the equivalent of 1,200,000 units of penicillin G with 900,000 units of penicillin G as the benzathine salt and 300,000 units of penicillin G as the procaine salt; this product is only indicated in pediatric patients.

Monitoring:

• Hematologic: Hematopoietic systems (during prolonged therapy, especially with high-dose regimens)
• Renal: Renal systems (during prolonged therapy, especially with high-dose regimens); renal function in elderly patients

Patient advice:

• Avoid missing doses and complete the entire course of therapy.
• Seek immediate medical attention if the following signs/symptoms develop: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.
• Consult physician at once if watery and bloody stools (with or without stomach cramps and fever) develop.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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