1. Penicillin G Sami al-aamery Clinical pharmacy PHCL 476 PHCL 476

2. Introduction Introduction Penicillin G One of the natural penicillins Penicillin G One of the natural penicillins Available in multi dosage form. Available in multi dosage form.

3. Indication Susceptible gram positive organisms (not S aureus). Susceptible gram positive organisms (not S aureus). Anthrax Anthrax Bacteremia Bacteremia Endocarditis, pericarditis Endocarditis, pericarditis

4. Indication (cont’) Respiratory tract infections Respiratory tract infections Meningitis Meningitis Neurosyphilis Neurosyphilis Skin/skin structure infections Skin/skin structure infections Rat bite fever Rat bite fever

5. contraindecation hypersensitivity to penicillin hypersensitivity to penicillin

6. Precautions COMMON hypersensitivity reactions hypersensitivity reactions eosinophilia eosinophilia

7. Precautions (cont’) SERIOUS hemolytic anemia (with large IV doses) hemolytic anemia (with large IV doses) hyperkalemia (high doses, decreased renal function) hyperkalemia (high doses, decreased renal function) hypersensitivity reactions hypersensitivity reactions interstitial nephritis (with rash, fever, eosinophilia) interstitial nephritis (with rash, fever, eosinophilia) seizures (patients with renal failure, infants, elderly, meningitis, history of seizures) seizures (patients with renal failure, infants, elderly, meningitis, history of seizures)

8. Drug interaction ethinyl estradiol ethinyl estradiol mestranol mestranol norelgestromin norelgestromin norethindrone norethindrone norgestrel norgestrel

9. Pregnancy CategoryPregnancy Category : c Pregnancy Category Breast Feeding Breast Feeding : safe Breast Feeding

10. Dosage adult (usual) Actinomycosis: 10-20 million units/day Actinomycosis: 10-20 million units/day Anthrax: naturally occurring, 2 million units IV/IM every 6 hr Anthrax: naturally occurring, 2 million units IV/IM every 6 hr Clostridial infections: 20 million units/day IV/IM divided every 4-6 hr Clostridial infections: 20 million units/day IV/IM divided every 4-6 hr Meningitis: 50,000 units/kg IV/IM every 4 hr Meningitis: 50,000 units/kg IV/IM every 4 hr Endocarditis: enterococcal, 18-30 million units/day IV divided every 4 hours Endocarditis: enterococcal, 18-30 million units/day IV divided every 4 hours

11. Dosage pediatric (usual) Susceptible infections: neonates 7 days of age and younger, 2kg and less, 50,000 units/kg/day divided every 12 hr Susceptible infections: neonates 7 days of age and younger, 2kg and less, 50,000 units/kg/day divided every 12 hr

12. Dosage pediatric (uaual) Susceptible infections: neonates over 7 days of age, less than 1.2kg, 50,000 units/kg/day divided every 12 hr Susceptible infections: neonates over 7 days of age, less than 1.2kg, 50,000 units/kg/day divided every 12 hr

13. Dosage adjustment renal impairment: CrCl 10- 50mL/min, 75% of usual dose at usual interval; CrCl less than 10 mL/min, 20-50% of usual dose at usual interval

14. Thank you For your attention