Dosing & Uses
Dosing Form & Strengths
injectable suspension
- 600,000 units/1mL
- 1.2 million units/2mL
- 2.4 million units/4mL
Group A Streptococcal Respiratory Infections
1.2 million U IM x1
Rheumatic Fever Prophylaxis
Acute attack: 1.2 million U IM monthly, OR
600,000 U IM q2Weeks
Syphilis
Primary or secondary (CDC Guidelines 2006)
- 2.4 million U IM x1
- If pregnant: 2.4 million U IM qWeek x2, recommended
- If HIV+: 2.4 million U IM qWeek x 3, recommended
Early Latent: 2.4 million U IM x1
Neurosyphilis: 2.4 million U IM qWeek x 3
Yaw, Bejel, & Pinta
1.2 million U IM x1
Renal Impairment
CrCl 10-50 mL/min: Decrease dose by 25%
CrCl <10 mL/min: Decrease dose by 50-70%
Hemodialysis: Removed by hemodialysis; administer after dialysis
Dosing Form & Strengths
injectable suspension
- 600,000 units/1mL syringe
- 1.2 million units/2mL syringe
- 2.4 million units/4mL syringe
Group A Streptococcal Infections
<27 kg: 600,000 U IM x1 (AHA guidelines 2009)
27 kg or greater: 1.2 million U IM x1 (AHA guidelines 2009)
Rheumatic Fever, Prophylaxis
<27 kg: 600,000 U IM q4Weeks; high-risk patients q3Weeks (AHA guidelines 2009)
27 kg or greater: 1.2 million U IM q4Weeks; high-risk patients q3Weeks (AHA guidelines 2009)
Syphilis
Congenital (<2 years old): 50,000 U/kg IM x 1 dose
Early: 50,000 U/kg IM x 1 dose; not to exceed 2.4 million units/dose
>1 year duration: 50,000 U/kg qWeek x3 weeks; not to exceed 2.5 million units/dose
Renal Impairment
Not defined in children; see adult recommendations
Adverse Effects
Frequency Not Defined
Skin rashes including maculopapular eruptions and exfoliative dermatitis
Urticaria
Serum-sicknesslike reactions (eg, chills, fever, edema, arthralgia, prostration)
Jarisch-Herxheimer reaction reported when treating syphilis
Pseudomembranous colitis
Warnings
Black Box Warnings
Not for IV use
Do not inject IV or admix with other IV solutions
Inadvertent intravenous administration, which has been associated with cardiorespiratory arrest and death reported; do not inject drug intravenously or admix with other intravenous solutions
Prior to administration, carefully read the warnings, adverse reactions, and dosage and administration sections of the labeling
Contraindications
Hypersensitivity; serious and occasionally fatal reactions have been reported
Cautions
For deep IM administration only; do not administer IV, SC, or IT
Do not inject near nerve or artery
Severe cutaneous adverse reactions (SCAR), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) reported in patients taking beta-lactam antibiotics; discontinue therapy when SCAR suspected; consider an alternative treatment
Pseudomembranous colitis reported with antibacterial agents, including penicillin G
Administer by deep intramuscular injection only in the upper, outer quadrant of buttock (dorsogluteal) or ventrogluteal site; quadriceps femoris fibrosis and atrophy reported following repeated intramuscular injections of penicillin preparations into anterolateral thigh and is not recommended
Pregnancy & Lactation
Pregnancy Category: B
Lactation: Excreted into breast milk, caution advised
Pregnancy Categories
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.Pharmacology
Half-Life: 20-30 minutes after hydrolysis to penicillin G
Absorption: IM, slow
Peak Plasma Concentration: 0.03-0.05 units/mL; levels persist for 5-14 days depending on dose
Protein Bound: 60%
Metabolism: ~30% in liver
Excretion: urine (60-90%)
Mechanism of Action
Interferes with cell wall mucopeptide synthesis during active multiplication, resulting in bactericidal activity against susceptible microorganisms
Administration
IM Administration
Do not inject near artery or nerve (may result in permanent neurologic damage)
Neonates, infants, small children: Midlateral aspect of thigh preferable
Older children and adults: Deep IM injection in upper outer quadrant of buttock
Because of high concentration of suspended matter, needle may be blocked if injection is not made at slow, steady rate
Storage
Store refrigerated at 2-8 degrees C (36-46 degrees F)
Do not freeze
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Bicillin L-A intramuscular - | 2,400,000 unit/4 mL solution |  | |
| Bicillin L-A intramuscular - | 1,200,000 unit/2 mL solution |  | |
| Bicillin L-A intramuscular - | 600,000 unit/mL solution |  | |
| Bicillin L-A intramuscular - | 600,000 unit/mL solution |  | |
| Bicillin L-A intramuscular - | 2,400,000 unit/4 mL solution |  | |
| Bicillin L-A intramuscular - | 1,200,000 unit/2 mL solution |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
penicillin G benzathine intramuscular
PENICILLIN G BENZATHINE - INJECTION
(PEN-i-SIL-in BEN-za-theen)
COMMON BRAND NAME(S): Bicillin L-A
WARNING: This medication must not be injected into a vein or mixed with solutions that will be injected into a vein because serious (possibly fatal) side effects can occur.
USES: Penicillin G benzathine is used to treat a wide variety of bacterial infections. It may also be used to prevent certain bacterial infections (such as rheumatic fever). This medication is a long-acting penicillin antibiotic. It works by stopping the growth of bacteria.
HOW TO USE: This medication is given by injection into a large muscle as directed by your doctor. The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on age and weight.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Do not inject into or near an artery, nerve, or vein. See also Warning section. Change the injection site each time to lessen injury to the muscle. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.For the best effect, follow your doctor's directions for when to receive this antibiotic, and make sure to not miss any doses.Continue to receive this medication for the full time prescribed, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Pain at the injection site, nausea, or vomiting may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: joint/muscle pain, vision changes, signs of a new infection (such as sore throat that doesn't go away, fever, chills), easy bruising/bleeding, unusual tiredness, mental/mood changes (such as confusion, hallucinations, depression, agitation).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.When used to treat syphilis and certain other infections, this medication may cause a reaction that occurs several hours after starting treatment and can last up to 24 hours. Tell your doctor right away if you have any of these symptoms: headache, fever/chills, sweating, joint/muscle pain, fast heartbeat, dizziness, worsening of skin sores or other disease symptoms.Get medical help right away if you have any very serious side effects, including: pain/redness/swelling/numbness/weakness of arms/legs, change in skin color near the injection site or on arms/legs, severe pain/peeling skin at the injection site, muscle cramps/weakness around the injection site, inability to move (paralysis), chest pain, swollen lymph nodes, severe stomach/abdominal pain, nausea/vomiting that doesn't stop, yellowing eyes/skin, irregular heartbeat, seizures, pink/bloody/dark urine, signs of kidney problems (such as a change in the amount of urine).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using this medication, tell your doctor or pharmacist if you are allergic to it; or to other antibiotics (such as other penicillins, cephalosporins); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease.This medication may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using this medication before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk in small amounts. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.One product that may interact with this drug is: methotrexate.This medication may interfere with certain lab tests (including certain urine glucose tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, kidney function tests, blood cultures) may be done if you are using this medication for a long time. Keep all medical and lab appointments.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Store in the refrigerator or as directed by your pharmacist. Do not freeze. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised October 2021. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
