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Penicillin G - Renal dosing

Usual Dosing (Adults)

Penicillin G:
1 – 4 mu q4-6h. 
(Susceptible infections: I.M., I.V.: 2-24 million units/day in divided doses every 4 hours depending on sensitivity of the organism and severity of the infection.)
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Penicillin VK:
250-500mg orally q6h.

DOSAGE AND ADMINISTRATION
Penicillin G Potassium Injection, USP should be administered by intravenous infusion. The usual dose recommendations are as follows:

Adult patients
*Because of its short half-life, Penicillin G is administered in divided doses,usually
every 4-6 hours with the exception of meningococcal meningitis/septicemia, i.e., every 2 hours.

CLINICAL INDICATION DOSAGE
Serious infections due to susceptible strains of streptococci (including S. pneumoniae)
-septicemia, empyema, pneumonia, pericarditis, endocarditis and meningitis
12 to 24 million units/day depending on the infection and its severity administered in equally divided doses every 4-6 hours.

Serious infections due to susceptible strains of staphylococci
- septicemia, empyema, pneumonia, pericarditis, endocarditis and meningitis
5 to 24 million units/day depending on the infection and its severity administered in equally divided doses every 4-6 hours.

Anthrax Minimum of 8 million units/day in divided doses every 6 hours. Higher doses may be required depending on susceptibility of organism.
Actinomycosis
    Cervicofacial disease
    Thoracic and abdominal disease
1 to 6 million units/day(*)
10 to 20 million units/day(*)
Clostridial infections
    Botulism (adjunctive therapy to antitoxin)
    Gas gangrene (debridement and/or surgery as indicated)
    Tetanus (adjunctive therapy to human tetanus immune globulin)
20 million units/day(*)
Diphtheria (adjunctive therapy to antitoxin and for the prevention of the carrier state) 2 to 3 million units/day in divided doses for 10-12 days(*)
Erysipelothrix endocarditis 12 to 20 million units/day for 4-6 weeks(*)
Fusospirochetosis (severe infections of the oropharynx [Vincent’s], lower respiratory tract and genital area) 5 to 10 million units/day(*)
Listeria infections
    Meningitis
    Endocarditis
15 to 20 million units/day for 2 weeks(*)
15 to 20 million units/day for 4 weeks(*)
Pasteurella infections including bacteremia and meningitis

4 to 6 million units/day for 2 weeks(*)
Haverhill fever; Rat-bite fever 12 to 20 million units/day for 3-4 weeks(*)

Disseminated gonococcal infections, such as meningitis endocarditis, arthritis, etc., caused by penicillin - susceptible organisms

10 million units/day(*); duration depends on the type of infection
Syphilis (neurosyphilis) 12 to 24 million units/day, as 2-4 MU every 4 hours for 10-14 days; many experts recommend additional therapy with Benzathine PCN G 2.4 MU IM weekly for 3 doses after completion of IV therapy

Meningococcal meningitis and/or septicemia 24 million units/day as 2 million units every 2 hours

Renal Dosing

dialysis Renal Impairment: Penicillin G is relatively nontoxic, and dosage adjustments are generally required only in cases of severe renal impairment. The recommended dosage regimens are as follows:

Creatinine clearance less than 10 mL/min/1.73m2; administer a full loading dose (see recommended dosages in the tables above) followed by one-half of the loading dose every 8-10 hours.

Uremic patients with a creatinine clearance greater than 10 mL/min/1.73m2; administer a full loading dose (see recommended dosages in the tables above) followed by one-half of the loading dose every 4-5 hours. Additional dosage modifications should be made in patients with hepatic disease and renal impairment.

Source:
PENICILLIN G POTASSIUM FOR INJECTION (penicillin g potassium) powder, for solution
[APP Pharmaceuticals, LLC] Schaumburg, IL 60173. Revised: 09/2009.

Hemodialysis

dialysis Dose as for CrCl<10.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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