d. Adverse Reactions.
(1) The following allergic reactions have been reported: skin rashes,
urticaria, and reactions resembling serum sickness including chills, fever, edema,
arthralgia, and prostration. Severe and occasionally fatal anaphylaxis has occurred.
(2) Hemolytic anemia, leukopenia, thrombocytopenia, nephropathy, and
neuropathy are rarely observed and usually associated with high intravenous dosage.
(3) Severe or even fatal potassium poisoning can occur, especially if renal
insufficiency is present in clients given continuous intravenous therapy with potassium
penicillin G in high dosage (10 to 100 million units/day).
(4) The Jarisch-Herxheimer reaction (increase in syphilitic symptoms) has
been reported in clients treated for syphilis.
e. Supply. This preparation, in dry powder form, must be reconstituted. It is
available in bottles of 1 and 5 million units for IM or IV use. It is also supplied as a 20
million unit vial for reconstitution and intravenous infusion only.
5-15. PROCAINE PENICILLIN G
a. Indications. Procaine penicillin G is a natural penicillin composed of
procaine and penicillin G administered intramuscularly as a suspension. Plateau-type
blood levels occur about 4 hours after injection and fall slowly over a period of the next
15 to 20 hours. Procaine penicillin G is indicated in the treatment of moderately severe
infections due to penicillin G-sensitive microorganisms that are sensitive to the low and
persistent serum levels common to this dosage form. The following infections will
usually respond to adequate doses of intramuscular procaine penicillin G.
Staphylococcal infections except penicillinase-resistant strains.
(3) Streptococcal infections Group A (without bacteremia). Group D
(enterococcus) are resistant.
Fusospirochetosis (Vincent's gingivitis and pharyngitis).
Treponema pallidum (syphilis); all stages.
Neisseria gonorrhoea (acute and chronic stages of gonorrhea).
Yaws, bejel, pinta.
(8) Corynebacterium diphtheriae--procaine penicillin G as an adjunct to
antitoxin for prevention of the carrier state of diphtheria.