ce of harmful effects on the fetus. Animal data have also not demonstrated any evidence of impaired fertility or harmful fetal effects. However, there are no adequate and well-controlled studies in pregnant women showing conclusively that harmful effects of penicillins on the fetus can be excluded. Because animal reproduction studies are not always predictive of human response, penicillin G should be used in pregnant women only if clearly needed.
Geriatric
Reported clinical experience with penicillin G procaine has not identified differences in responses between geriatric patients and younger adult patients. Since penicillin G procaine is known to be substantially excreted by the kidney and elderly patients may also have decreased renal function, care should be taken in dose selection. It may be useful to monitor renal function. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). According to OBRA, use of antibiotics should be limited to confirmed or suspected bacterial infections. Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, colitis, or vaginitis. Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions.
Infants, neonates
Incomplete development of renal function in neonates and infants may delay elimination of penicillin. Pediatric doses are generally determined by weight and should be calculated for each individual patient. All newborns treated with penicillin G procaine should be monitored for clinical and laboratory evidence of toxic or adverse effects.
ADVERSE REACTIONS
Severe
serum sickness / Delayed / 2.0-5.0
Stevens-Johnson syndrome / Delayed / 0-1.0
exfoliative dermatitis / Delayed / 0-1.0
angioedema / Rapid / 0-1.0
anaphylactic shock / Rapid / 0-1.0
anaphylactoid reactions / Rapid / 0-1.0
toxic epidermal necrolysis / Delayed / 0-1.0
acute generalized exanthematous pustulosis (AGEP) / Delayed / 0-1.0
seizures / Delayed / Incidence not known
hemolytic anemia / Delayed / Incidence not known
Moderate
pseudomembranous colitis / Delayed / 1.0-10.0
superinfection / Delayed / 1.0-10.0
edema / Delayed / 2.0-5.0
depression / Delayed / Incidence not known
confusion / Early / Incidence not known
hallucinations / Early / Incidence not known
elevated hepatic enzymes / Delayed / Incidence not known
leukopenia / Delayed / Incidence not known
thrombocytopenia / Delayed / Incidence not known
Mild
urticaria / Rapid / 2.0-5.0
rash (unspecified) / Early / 2.0-5.0
fever / Early / 2.0-5.0
arthralgia / Delayed / 2.0-5.0
chills / Rapid / 2.0-5.0
maculopapular rash / Early / 2.0-5.0
nausea / Early / 2.0-5.0
tongue discoloration / Delayed / 2.0-5.0
vomiting / Early / 2.0-5.0
diarrhea / Early / 2.0-5.0
agitation / Early / Incidence not known
weakness / Early / Incidence not known
anxiety / Delayed / Incidence not known
headache / Early / Incidence not known
myalgia / Early / Incidence not known
injection site reaction / Rapid / Incidence not known
DRUG INTERACTIONS
Acetaminophen; Aspirin, ASA; Caffeine: Due to the high protein binding of aspirin, it could displace or be displaced from binding sites by other highly protein-bound drugs, such as penicillins. Also, aspirin may compete with penicillin for renal tubular secretion, inc |
