Brand and Other Names:
- Classes: Antibiotics, Other
Dosing & Uses
IV: 15,000-25,000 units/kg/day divided q12hr; not to exceed 25,000 units/kg/day
IM: 25,000-30,000 units/kg/day divided q4-6hr
Intrathecal: 50,000 qDay for 3-4 days; then qDay or qODay for at least 2 weeks after CSF cultures are negative and normal for glucose content
Total daily dose not to exceed 2,000,000 units/day
CrCl >20 mL/minute: give 75-100% usual dose/day divided q12hr
CrCl 5-20 mL/minute: give 50% usual dose/day divided q12hr
CrCl <5 mL/minute: give 15% usual dose/day q12hr
Monitor: renal function
Other Indications & Uses
Bacterial Septicemia due to P. aeruginosa, E. aerogenes, & K. pneumoniae, H. Influenzae Meningitis, UTI due to E. coli
- IM: May receive up to 40,000 units/kg/day divided q6hr if renal function healthy
- IV: May receive up to 40,000 units/kg/day divided q12hr;
- Intrathecal: 20,000 units/day for 3-4 days; follow with 25,000 units qODay for at least 2 weeks after CSF cultures are negative and CSF (glucose) has returned to normal
- IM: 25,000-30,000 units/kg/day divided q12hr
- IV: 15,000-25,000 units/kg/day divided q12hr; not to exceed 25,000 units/kg/day
- Intrathecal: 50,000 qDay for 3-4 days; then qDay or qODay for at least 2 weeks after CSF cultures are negative and normal for glucose content
CrCl >20 mL/min: give 75-100% usual dose/day divided q12hr
CrCl 5-20 mL/min: give 50% usual dose/day divided q12hr
CrCl <5 mL/min: give 15% usual dose/day q12hr
Monitor: renal function
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Anaphylactoid reactions with dyspnea and tachycardia
Oliguria, myasthenia gravis, pregnancy, renal disease
Potential risk of nephrotoxicity and neurotoxicity
May inhibit neuromuscular transmission
Inactivated by strong acidic or alkaline solution
Discontinue if diminished urine output, rise in SCr or BUN, or signs of respiratory paralysis appear
Do not use IM routinely, particularly in peds, because of severe inj site pain
Pregnancy & Lactation
Pregnancy Category: B: use when benefits outweigh risks
Lactation: use caution; no data
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Distribution: wide, does not cross placenta or aqueous humor of eye; does not appear in CSF or synovial fluid
Time: IM: 2 hr
Concentration: 20-40 KU IM dose: 1-8 mcg/mL
Protein Bound: 79-92%
Half-life elimination: 4.3-6 hr with normal renal function
Excretion: urine 60% (<1% as unchanged drug)
Dialyzable: HD; no; PD: no
Mechanism of Action
Bactericidal; causes leakage of bacterial membrane by binding to phospholipids.
Additive: amphotericin B, chloramphenicol Na succinate, chlorothiazide, heparin, MgSO4
Additive: amikacin, ascorbic acid, colistimethate, diphenhyramine, erythromycin lactobionate, hydrocortisone Na succinate, kanamycin, pencillin G potassium, penicillin G Na, phenobarbital, ranitidine, vit B/C
Syringe: penicillin G Na
IV: dilute 500,000 U in 300-500 mL D5W
IM: reconstitute vial with 2 mL SWI , NS, or procaine HCl 1% solution
Intrathecal (IT): reconstitute vial with10 mL NS; DO NOT use procaine HCl for IT
IV: infuse over 60-90 min
IM: give deep into upper outer quadrant of gluteal muscles
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