|PENICILLIN G BENZATHINE
Bicillin, Bicillin L-A, Permapen
Classifications: beta-lactam antibiotic; natural penicillin; Therapeutic: antibiotic; beta-lactam
Prototype: Penicillin G potassium
Pregnancy Category: B
300,000 units/mL, 600,000 units/mL, 1,200,000 units/2 mL, 2,400,000 units/4 mL injection
Acid-stable, penicillinase-sensitive, long-acting form of penicillin G. Absorbed slowly in body because of extremely low
water solubility. Produces lower blood concentrations than other penicillin G compounds but has the longest duration of antimicrobial
activity of all other available parenteral or repository penicillins.
Effective against many strains of Staphylococcus aureus, gram-positive cocci, gram-negative cocci. Also effective against gram-positive bacilli and gram-negative bacilli.
Infections highly susceptible to penicillin G, such as streptococcal, pneumococcal, and staphylococcal infections, venereal
disease such as syphilis (including early, late, and congenital forms), and nonvenereal diseases (e.g., yaws, bejel, and
pinta). Also used in prophylaxis of rheumatic fever.
Hypersensitivity to penicillins or cephalosporins; lactation.
History of or suspected allergy (eczema, hives, hay fever, asthma); renal disease, renal impairment; GI disease; pregnancy
(category B); infants, neonates.
Route & Dosage
|Mild to Moderate Infections
Adult: IM 1,200,000 U once/d
Child: IM >27 kg, 900,000 U once/d; <27 kg, 300,000600,000 U once/d
Adult: IM <1 y duration: 2,400,000 U as single dose; >1 y duration: 2,400,000 U/wk for 3 wk
Child: IM Congenital: 50,000 U/kg as single dose
Prophylaxis for Rheumatic Fever
Adult: IM 1,200,000 U q4wk
Child: IM 1,200,000 U q34wk
- Do not confuse penicillin G benzathine with preparations containing procaine penicillin G (e.g., Bicillin C-R).
- Make IM injection deep into upper outer quadrant of buttock. In infants and small children, the preferred site is the midlateral
aspect of the thigh.
- Shake multiple-dose vial vigorously before withdrawing desired IM dose. Shake prepared cartridge unit vigorously before
- Select IM site with care. Injection into or near a major peripheral nerve can result in nerve damage.
- Inadvertent IV administration has resulted in arterial occlusion and cardiac arrest.
- Make injections at a slow steady rate to prevent needle blockage.
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%)Body as a Whole: Local pain,
tenderness, and fever associated with IM injection, chills, fever, wheezing, anaphylaxis,
; superinfections, Jarisch-Herxheimer reaction in patients with syphilis. Skin:
Pruritus, urticaria, and other skin eruptions. Hematologic:
Eosinophilia, hemolytic anemia, and other blood abnormalities. Also see PENICILLIN G POTASSIUM
elimination; may decrease efficacy of oral contraceptives
Slowly absorbed from IM site. Peak:
1224 h. Duration:
26 d. Distribution:
Crosses placenta; distributed into breast milk. Metabolism:
Hydrolyzed to penicillin in body. Elimination:
Excreted slowly by kidneys.
Note: See penicillin G potassium for numerous additional clinical implications.
Assessment & Drug Effects
- Determine history of hypersensitivity reactions to penicillins, cephalosporins, or other allergens prior to initiation of
- Lab tests: Perform C&S tests prior to initiation of therapy and periodically thereafter. Perform periodic renal function
Patient & Family Education
- Report immediately to physician the onset of an allergic reaction. There is great risk of severe and prolonged reactions
because drug is absorbed so slowly.