Generic Name
penicillin G
benzathine
Trade Name
Bicillin L-A
Classification
Penicillin-Anti-
infective
Mechanism of
Action
Inhibits biosynthesis
of cell-wall
mucopeptide; kills
penicillin-
susceptible bacteria
during
activemultiplication
stage
Indications and
dosages
>Upper respiratory
infections
Adults:
1.2 million units
I.M. as a single dose
Ch ildren weighing 27 kg (60) or more:
900,000 units I.M. as a single dose
Infants and children weighing less than 27 kg (60 lb):
300,000 to 600,000 units I.M. as a singledose>Early syphilis (primary, secondary, or latent)
Adults:
2.4 million units I.M. as a single dose
Children:
50,000 units/kg I.M. as a single dose, increased as needed up to adult dosage>Congenital syphilis
Children younger than age 2:
50,000 units/kg I.M. as a single dose>Late (tertiary) syphilis and neurosyphilis
Adults:
2.4 million units I.M. q week for up to 3 weeks, after aqueous penicillin G or procaine penicillin therapy>Gummas and cardiovascular syphilis
Adults:
2.4 million units I.M. q week for 3 weeks>Yaws, bejel, and pinta
Adults:
1.2 million units I.M. as a single dose>Prophylaxis of rheumatic fever and glomerulonephritis
Adults:
After acute attack, 1.2 million units I.M. q month or 600,000 units q 2 weeks
Adverse Reactions
CNS:
headache, lethargy, hallucinations, anxiety, neuropathy, fatigue, nervousness, tremors,euphoria, asthenia, Hoigne's syndrome,
cerebrovascular accident, seizures, coma
CV:
hypotension, pulmonary hypertension, vasodilation, vasovagal reaction, syncope, palpitations, tachycardia,
cardiac arrest, pulmonary embolism
EENT:
blurred vision, vision loss, laryngeal edema
GI:
nausea, vomiting, diarrhea, epigastric distress, abdominal pain, colitis, blood in stool,glossitis,
pseudomembranous colitis
GU:
hematuria, proteinuria, urogenic bladder, erectile dysfunction, priapism, nephropathy,
renalfailure
Hematologic: hemolytic anemia, leukopenia, thrombocytopenia
Metabolic:
hypernatremia,
hyperkalemia
Respiratory:
dyspnea, hypoxia,
apnea, pulmonary embolism
Skin:
rash, urticaria, sweating
Other:
fever, superinfection, injection site reactions and pain, Jarisch-Hersheimer reaction,
anaphylaxis, serum sickness
Interactions
Aspirin, probenecid:
increased penicillin blood level
Erythromycins , tetracyclines:
decreased antimicrobial activity of penicillin
Hormonased contraceptive efficacy
Action: Interferes with cell wall replication of susceptible organisms; osmotically
unstable cell wall swells, bursts from osmotic pressure, results in cell death
Therapeutic Outcome: Bactericidal effects on the gram-positive cocci (Staphylococcus,
Streptococcus pyogenes, S. viridans, S. faecalis, S. bovis, S. pneumoniae), gram-negative
cocci (Neisseria gonorrhoeae), gram-positive bacilli (Bacillus anthracis, Clostridium
perfringens, C. tetani, Corynebacterium diphtheriae, Listeria monocytogenes), gram-
negative bacilli (Escherichia coli, Proteus mirabilis, Salmonella, Shigella, Enterobacter,
Streptobacillus moniliformis), spirochetes (Treponema pallidum; Actinomyces)
Uses: Respiratory infections, scarlet fever, erysipelas, otitis media, pneumonia, skin and
soft tissue infections, gonorrhea; prevention of rheumatic fever; glomerulonephritis
Dosages and routes:
Moderate to severe infections
Adult and child: IM 600,000-1.2 million units in 1 or 2 doses/day for 10 days to 2
wk
Newborn: 50,000 units/kg IM once daily (avoid use in newborns)
Gonorrhea
Adult and child >12 yr: IM 4.8 million units in two injections given 30 min after
probenecid 1 g
Pneumococcal pneumonia
Adult/child >12 yr: IM 600,000-1.2 million units/day 7-10 days
Renal dose
CCr 10-30 ml/min give q8-12h; CCr < 10 ml/min give q12-18h
Available Forms: Inj 300,000, 500,000, 600,000, 1,200,000, 2,400,000 units/dose
Side effects/adverse reactions:
CNS: Lethargy, hallucinations, anxiety, depression, twitching, coma, seizures
GI: Nausea, vomiting, diarrhea, increased AST, ALT, abdominal pain, glossitis,
colitis
GU: Oliguria, proteinuria, hematuria, vaginitis, moniliasis, glomerulonephritis
HEMA: Anemia, increased bleeding time, bone marrow depression,
granulocytopenia
META: Hyperkalemia, hypokalemia, alkalosis, hypernatremia
MISC: Anaphylaxis, local pain, tenderness and fever with IM injection
Contraindications: Hypersensitivity to penicillins; neonates
Precautions: Hypersensitivity to cephalosporins, pregnancy (B), lactation, severe renal
disease
Pharmacokinetics
Delayed; prolonged drug
Absorption
levels
Widely distributed;
Distribution
crosses placenta
Metabolism Liver, minimally
Kidneys, unchanged;
Excretion
breast milk
Half-life 1/2 - 1 hr
Pharmacodynamics
Onset Slow
Peak 1- 4 hr
Duration 15 hr
Interactions:
Individual drugs
Aspirin: penicillin concentrations renal excretion
Drug classifications
Erythromycins, tetracyclines: antimicrobial effectiveness
Oral anticoagulants: anticoagulant effects
Oral contraceptives: effect of oral contraceptives
Herb/drug
Acidophilus: do not use with antiinfectives
Khat: absorption of penicillin; separate doses by 2 hr or more
Lab test interferences
False positive: Urine glucose, urine protein
NURSING CONSIDERATIONS
Assessment
Assess patient for previous sensitivity reaction to penicillins or
cephalosporins; cross-sensitivity between penicillins and cephalosporins is
common
Assess patient for signs and symptoms of infection including characteristics of
wounds, sputum, urine, stool, WBC >10,000/mm3, earache, fever; obtain
baseline information and information during treatment
Obtain C&S before beginning drug therapy to identify if correct treatment has
been initiated
Assess for allergic reactions: rash, urticaria, pruritis, chills, fever, joint pain;
angioedema may occur a few days after therapy begins; epinephrine,
resuscitation equipment should be available for anaphylactic reaction
! Identify urine output; if decreasing, notify prescriber (may indicate
nephrotoxicity); also check for increased BUN, creatinine
Monitor blood studies: CBC, Hct, bilirubin, LDH, alkaline phosphatase, AST,
ALT, Coombs' test monthly if patient is on long-term therapy
Monitor electrolytes: potassium, sodium, chloride monthly if patient is on
long-term therapy
Assess bowel pattern daily; if severe diarrhea occurs, drug should be
discontinued; may indicate pseudomembranous colitis
Monitor for bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac
daily if on long-term therapy
Assess for overgrowth of infection: perineal itching, fever, malaise, redness,
pain, swelling, drainage, rash, diarrhea, change in cough, sputum
Nursing diagnoses
Infection, risk for (uses)
Diarrhea (adverse reactions)
Injury, risk for (adverse reactions)
Knowledge, deficient (teaching)
Noncompliance (teaching)
Implementation
Do not give IV
Give deeply in large muscle mass
Reconstitute with 0.9% NaCl, sterile water for inj, D5W; refrigerate unused
portion
Shake medication before administering
IM route may include procaine reactions: fear of death, depression, seizures,
anxiety, confusion, hallucinations
Patient/family education
Teach patient to report sore throat, bruising, bleeding, joint pain; may
indicate blood dyscrasias (rare)
Advise patient to contact prescriber if vaginal itching, loose, foul-smelling
stools, furry tongue occur; may indicate superinfection
Instruct patient to take all medication prescribed for the length of time
ordered
Advise patient to notify prescriber of diarrhea with blood or pus, which may
indicate pseudomembranous colitis
Positive therapeutic outcome
Absence of signs/symptoms of infection (WBC<10,000/mm3, temp WNL,
absence of red, draining wounds, earache)
Reported improvement in symptoms of infection
