treatment of syphilis, including neurosyphilis; yaws (Treponema pallidum ssp. pertenue); pinta (Treponema carateum); and bejel (Treponema pallidum ssp. endemicum).
NOTE: The Jarisch-Herxheimer reaction may occur within the first 24 hours of therapy.
For the treatment of primary, secondary, or early latent (less than 1 year duration) syphilis, yaws , pinta , and bejel.
Intramuscular dosage
Adults and Adolescents
600,000 units IM once daily for 8 days. The CDC recommends penicillin G benzathine for syphilis.
For the treatment of late latent (greater than 1 year duration) syphilis, yaws, pinta, and bejel.
Intramuscular dosage
Adults and Adolescents
600,000 units IM once daily for 10 to 15 days. The CDC recommends penicillin G benzathine for syphilis.
For the treatment of tertiary syphilis (patients with gumma and cardiovascular syphilis), yaws, pinta, and bejel.
Intramuscular dosage
Adults and Adolescents
600,000 units IM once daily for 10 to 15 days. The CDC recommends penicillin G benzathine for syphilis.
For the treatment of neurosyphilis.
Intramuscular dosage
Adults and Adolescents
As an alternative to aqueous crystalline penicillin G and when compliance can be ensured, guidelines recommend 2.4 million units IM once daily plus probenecid 500 mg PO 4 times a day, both given for 10 to 14 days. The CDC suggests that penicillin G benzathine 2.4 million units IM once weekly for up to 3 successive weeks after the completion of a neurosyphilis regimen may be considered to provide a comparable duration of treatment for late syphilis. For HIV-infected patients, guidelines recommend follow-up therapy of benzathine penicillin 2.4 million units IM once weekly for 3 weeks after completion of procaine penicillin G and probenecid therapy. The manufacturer recommends penicillin G procaine 600,000 units IM once daily for 10 to 15 days.
For the treatment of congenital syphilis.
NOTE: Current CDC guidelines should be consulted to determine the appropriate course of treatment in neonates born to mothers with syphilis. Therapy is based on physical examination, serum quantitive nontreponemal serologic titer, and whether or not the mother was treated properly before delivery.
Intramuscular dosage
Infants and Children
Any child older than 1 month suspected of having congenital syphilis or who has neurologic involvement should be treated with aqueous penicillin G. During an aqueous penicillin G shortage, penicillin G procaine 50,000 units/kg IM as a single daily injection (Max: 600,000 units/day) for 10 days may be considered. If more than 1 day of therapy is missed, the entire course should be restarted.
Neonates
50,000 units/kg IM once daily as a single injection for 10 days as an option. If more than 1 day of therapy is missed, the entire course should be restarted.
MAXIMUM DOSAGE
Adults
2.4 million units/day IM; 4.8 million units/day IM has been recommended by guidelines.
Geriatric
2.4 million units/day IM; 4.8 million units/day IM has been recommended by guidelines.
Adolescents
50,000 units/kg/day IM up to 2.4 million units/day IM..
Children
50,000 units/kg/day IM up to 2.4 million units/day IM.
Infants
50,000 units/kg/day IM.
Neonates
50,000 units/kg/day IM.
DOSING CONSIDERATIONS
Hepatic Impairment
No dosage adjustment required.
Renal Impairment
Penicillin G is rapidly eliminated via renal tubular excretion and clearance is significantly delayed in patients with decreased renal functi |
