Procaine benzylpenicillin

Procaine benzylpenicillin also known as penicillin G procaine, is an antibiotic useful for the treatment of a number of bacterial infections.[2] Specifically it is used for syphilis, anthrax, mouth infections, pneumonia, diphtheria, cellulitis, and animal bites.[2] It is given by injection into a muscle.[2]

Procaine benzylpenicillin
Combination of
Benzylpenicillinantibiotic
Procaineanaesthetic
Clinical data
Trade namesBicillin C-R,[1] other
Other namespenicillin G procaine, procaine penicillin G, procaine penicillin
AHFS/Drugs.comFDA Professional Drug Information
Pregnancy
category
  • US: B (No risk in non-human studies) [1]
    Routes of
    administration    		IM
    ATC code
    Legal status
    Legal status
    Identifiers
    CAS Number
    ChEMBL
    E numberE707 (antibiotics)
    ECHA InfoCard100.000.187
     NY (what is this?)  (verify)

    Side effects include pain at the site of injection, blood clotting problems, seizures, and allergic reactions including anaphylaxis.[2] When used to treat syphilis a reaction known as Jarisch-Herxheimer may occur.[2] It is not recommended in those with a history of penicillin allergy or procaine allergy.[1][2] Use during pregnancy and breastfeeding is relatively safe.[1][2] Procaine benzylpenicillin is in the penicillin and beta lactam family of medications.[2] It works via benzylpenicillin and results in bacterial death.[2][3] Procaine makes the combination long acting.[4]

    Procaine benzylpenicillin was introduced for medical use in 1948.[3] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[5] The wholesale cost in the developing world is about US$0.09–0.18 per day.[6] In the United States a course of treatment costs $100–200.[1]

    Medical uses

    Specific indications for procaine penicillin include:[7]

    • Syphilis
      • In the United States, Bicillin C-R (a injectable suspension which 1.2 million units of benzathine penicillin and 1.2 million units of procaine penicillin per 4 ml) is not recommended for treating syphilis, since it contains only half the recommended dose of benzathine penicillin. Medication errors have been made due to the confusion between Bicillin L-A & Bicillin C-R.[8] As a result, changes in product packaging have been made; specifically, the statement "Not for the Treatment of Syphilis" has been added in red text to both the Bicillin CR and Billin CR 900/300 syringe labels.[9]
    • Respiratory tract infections where compliance with oral treatment is unlikely
    • Alongside Pen V and Erythromycin, Bicillin C-R is used to treat strep throat, given as one IM injection
    • Cellulitis, erysipelas
    • Procaine penicillin is also used as an adjunct in the treatment of anthrax.

    Adverse effects
    Further information: Penicillin drug reaction

    At high doses procaine penicillin can cause seizures and CNS abnormalities due to procaine present in it.

    Mechanism

    It is a form of penicillin which is a combination of benzylpenicillin and the local anaesthetic agent procaine.[10] Following deep intramuscular injection, it is slowly absorbed into the circulation and hydrolysed to benzylpenicillin — thus it is used where prolonged low concentrations of benzylpenicillin are required.

    Compendial status

    References
    1. Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 95. ISBN 9781284057560.
    2. WHO Model Formulary 2008 (PDF). World Health Organization. 2009. pp. 113, 607, 618. ISBN 9789241547659. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
    3. "Penicillin G Procaine - FDA prescribing information, side effects and uses". www.drugs.com. Archived from the original on 20 December 2016. Retrieved 10 December 2016.
    4. Ebadi, Manuchair (2007). Desk Reference of Clinical Pharmacology, Second Edition. CRC Press. p. 555. ISBN 9781420047448. Archived from the original on 2016-12-20.
    5. "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
    6. "Penicillin, Procaine Benzyl". International Drug Price Indicator Guide. Retrieved 8 December 2016.
    7. Rossi S, ed. (2006). Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. ISBN 0-9757919-2-3.
    8. Centers for Disease Control and Prevention (CDC) (2005). "Inadvertent use of Bicillin C-R to treat syphilis infection—Los Angeles, California, 1999–2004". MMWR Morb. Mortal. Wkly. Rep. 54 (9): 217–9. PMID 15758893.
    9. United States Food & Drug Administration. "FDA Strengthens Labels of Two Specific Types of Antibiotics to Ensure Proper Use." Archived 2009-01-14 at the Wayback Machine Published December 1, 2004. Last accessed June 18, 2007.
    10. Residues of Some Veterinary Drugs in Animals and Foods: Monographs Prepared by the Fiftieth Meeting of the Joint FAO/WHO Expert Committee on Food Additives : Rome, 17-26 February 1998. Food & Agriculture Org. 1999. p. 96. ISBN 9789251042809. Archived from the original on 20 December 2016.
    11. British Pharmacopoeia Commission Secretariat. "Index (BP 2009)" (PDF). Archived from the original (PDF) on 11 April 2009. Retrieved 26 March 2010.
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