be used.
Intravenous administration
Penicillin G procaine must be administered by the intramuscular (IM) route only. Never administer penicillin G procaine via intravenous administration. Special precautions should be taken to avoid intravascular injection. Avoid intramuscular injection of these suspensions near major nerves or blood vessels because this could cause neurovascular damage.
Colitis, diarrhea, GI disease, inflammatory bowel disease, pseudomembranous colitis, ulcerative colitis
Almost all antibacterial agents have been associated with pseudomembranous colitis (antibiotic-associated colitis) which may range in severity from mild to life-threatening. In the colon, overgrowth of Clostridia may exist when normal flora is altered subsequent to antibacterial administration. The toxin produced by Clostridium difficile is a primary cause of pseudomembranous colitis. It is known that systemic use of antibiotics predisposes patients to development of pseudomembranous colitis. Consideration should be given to the diagnosis of pseudomembranous colitis in patients presenting with diarrhea following penicillin G procaine administration. Systemic antibiotics should be prescribed with caution to patients with inflammatory bowel disease such as ulcerative colitis or other GI disease. If diarrhea develops during therapy, the drug should be discontinued. Following diagnosis of pseudomembranous colitis, therapeutic measures should be instituted. In milder cases, the colitis may respond to discontinuation of the offending agent. In moderate to severe cases, fluids and electrolytes, protein supplementation, and treatment with an antibacterial effective against Clostridium difficile may be warranted. Products inhibiting peristalsis are contraindicated in this clinical situation. Practitioners should be aware that antibiotic-associated colitis has been observed to occur over two months or more following discontinuation of systemic antibiotic therapy; a careful medical history should be taken.
Renal failure, renal impairment
Penicillin G is eliminated primarily unchanged via renal tubular secretion. With normal renal function the drug is rapidly eliminated. In individuals with renal impairment or renal failure, excretion is considerably delayed. Dosages of penicillin G procaine may need to be reduced in these patients. Large doses of penicillin administered to patients with renal impairment have been associated with seizures.
Breast-feeding
Penicillins are excreted in breast milk. The manufacturer recommends caution with the use of penicillin G procaine during nursing. However, unless the infant is allergic to penicillins, breast-feeding is generally safe during maternal penicillin G procaine therapy. Breast milk concentrations range from 0.015—0.37 mcg/ml with a milk:plasma ratio of 0.02—0.13. Penicillins may cause diarrhea, candidiasis, and skin rash in the breast-feeding infant. The infant should be observed for potential effects. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.
Pregnancy
Penicillin G Procaine is classified in FDA pregnancy risk category B. Use of penicillins in humans has not shown any eviden |
