penicillin G benzathine/penicillin G procaine (Bicillin C-R, Bicillin C-R 900/300)
Classes: Penicillins, Natural
- Dosing and uses of Bicillin C-R, Bicillin C-R 900/300 (penicillin G benzathine/penicillin G procaine)
- Bicillin C-R, Bicillin C-R 900/300 (penicillin G benzathine/penicillin G procaine) adverse (side) effects
- Warnings
- Pregnancy
- Pharmacology of Bicillin C-R, Bicillin C-R 900/300 (penicillin G benzathine/penicillin G procaine)
- Administration
Dosing and uses of Bicillin C-R, Bicillin C-R 900/300 (penicillin G benzathine/penicillin G procaine)
Adult dosage forms and strengths
penicillin G benzathine/penicillin G procaine
injectable suspension
- 600,000units/600,000units/2mL (ie, 1.2 million units/2mL)
- 900,000units/300,000units/2mL (ie, 1.2 million units/2mL)
Streptococcal Group A Infections
Indicated for moderately severe-to-severe infections of upper-respiratory tract, scarlet fever, erysipelas, and skin and soft-tissue infections caused by streptococcal Group A
2.4 million units IM x1; divided dosage administration into multiple site
Alternatively, administer 1.2 million units IM on day 1, then repeat dose on day 3
Pneumococcal Infections
NOT for pneumococcal meningitis
1.2 million units IM; repeat q2-3 days until temperature is normal for 48 hr; other penicillin forms (ie, IV) necessary for severe infection
Renal Impairment
CrCl 10-50 mL/min: Decrease dose by 25%
CrCl <10 mL/min: Decrease dose by 50-70%
Hemodialysis: Removed by hemodialysis; administer after dialysis
Pediatric dosage forms and strengths
penicillin G benzathine/penicillin G procaine
injectable suspension
- 600,000units/600,000units/2mL (ie, 1.2 million units/2mL)
- 900,000units/300,000units/2mL (ie, 1.2 million units/2mL)
Streptococcal Group A Infections
Indicated for moderately severe-to-severe infections of upper-respiratory tract, scarlet fever, erysipelas, and skin and soft-tissue infections caused by streptococcal Group A
Bicillin C-r
- <14 kg: 600,000 units IM x1
- 14-27 kg: 900,000-1,200,000 units IM x1
- 27 kg or more: As adults; 2.4 million units IM x1; divided dosage administration into multiple site; alternatively, administer 1.2 million units IM on day 1, then repeat dose on day 3
Bicillin C-R 900/300
- 900 units/300 units IM x1
Pneumococcal Infections
NOT for pneumococcal meningitis
Bicillin C-R: 600,000 units IM; repeat q2-3 days until temperature is normal for 48 hr; other penicillin forms (ie, IV) necessary for severe infection
Bicillin C-R 900/300: 900 units/300 units IM; repeat q2-3 days until temperature is normal for 48 hr; other penicillin forms (ie, IV) necessary for severe infection
Renal Impairment
Not defined in children; see adult recommendations
Bicillin C-R, Bicillin C-R 900/300 (penicillin G benzathine/penicillin G procaine) adverse (side) effects
Frequency not defined
Skin rashes including maculopapular eruptions and exfoliative dermatitis
Urticaria
Serum-sicknesslike reactions (eg, chills, fever, edema, arthralgia, prostration)
Jarisch-Herxheimer reaction reported when treating syphilis
Pseudomembranous colitis
Warnings
Black box warnings
Not for IV use
Do not inject IV or admix with other IV solutions
Reports of inadvertent IV administration associated with cardiorespiratory arrest and death
Prior to administration, carefully read the warnings, adverse reactions, and dosage and administration sections of the labeling
Contraindications
Hypersensitivity; serious and occasionally fatal reactions have been reported
Cautions
For deep IM administration only; do not administer IV, SC, or It
Do not inject near nerve or artery
Pseudomembranous colitis reported with antibacterial agents, including penicillin g
Procaine reactions: Immediate toxic reactions to procaine reported, particularly when a large single dose is administered (4.8 million units); reaction manifested by mental disturbances including anxiety, confusion, agitation, depression, weakness, seizures, hallucinations, combativeness, and fear
Avoid use in neonates; increased risk for sterile abscess development and procaine toxicity
Severe pneumonia, empyema, bacteremia, pericarditis\is, meningitis, peritonitis, and arthritis of pneumococcal etiology are better treated with penicillin G sodium or potassium during the acute stage
When high, sustained serum levels are required, penicillin G sodium or potassium, either IM or IV, should be used
NOT indicated for treatment of venereal diseases, including syphilis, gonorrhea, yaws, bejel, and pinta
Pregnancy and lactation
Pregnancy category: B
Lactation: Excreted into breast milk, caution advised
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Bicillin C-R, Bicillin C-R 900/300 (penicillin G benzathine/penicillin G procaine)
Half-Life: 20-30 minutes after hydrolysis to penicillin g
Absorption: IM, slow
Peak Plasma Time: 3 hr
Peak Plasma Concentration: 1-1.3 units/mL
Protein Bound: 60%
Metabolism: ~30% in liver
Excretion: urine (60-90%)
Mechanism of action
Interferes with cell wall mucopeptide synthesis during active multiplication, resulting in bactericidal activity against susceptible microorganisms
Administration
IV Administration
Do not inject near artery or nerve (may result in permanent neurologic damage)
Neonates, infants, small children: Midlateral aspect of thigh preferable
Older children and adults: Deep IM injection in upper outer quadrant of buttock
Because of high concentration of suspended matter, needle may be blocked if injection is not made at slow, steady rate
Storage
Store refrigerated at 2-8 degrees C (36-46 degrees F)
Do not freeze