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Benzathine benzylpenicillin

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Benzathine benzylpenicillin
Benzathine benzylpenicillin.svg
Combination of
Benzylpenicillin antibiotic
Benzathine stabilizer
Clinical data
Trade names Bicillin L-A, [1] Permapen, others
Other namespenicillin benzathine benzyl, benzathine penicillin, penicillin G benzathine, benzylpenicillin benzathine [2]
AHFS/Drugs.com Professional Drug Facts
License data
Pregnancy
category
  • AU:A
Routes of
administration 		Intramuscular injection [3]
ATC code
Legal status
Legal status
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
E number E708 (antibiotics) OOjs UI icon edit-ltr-progressive.svg
CompTox Dashboard (EPA)
ECHA InfoCard 100.014.782 OOjs UI icon edit-ltr-progressive.svg
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Benzathine benzylpenicillin, also known as benzathine penicillin G (BPG), is an antibiotic medication useful for the treatment of a number of bacterial infections. [3] Specifically it is used to treat strep throat, diphtheria, syphilis, and yaws. [3] [5] It is also used to prevent rheumatic fever. [5] It is given by injection into a muscle. [3] [5] It is known as "Peanut Butter Shot" in US military slang due to its viscosity. [6]

Contents

Side effects include allergic reactions including anaphylaxis, and the site of injection is notoriously painful. [5] When used to treat syphilis a Jarisch–Herxheimer reaction may occur. [5] It is not recommended in those with a history of penicillin allergy or those with syphilis involving the nervous system. [5] [3] Use during pregnancy is generally safe. [3] It is in the penicillin and beta lactam class of medications and works via benzylpenicillin. [3] [5] The benzathine component slowly releases the penicillin making the combination long acting. [7]

Benzathine benzylpenicillin was patented in 1950. [2] [8] It is on the World Health Organization's List of Essential Medicines. [9]

Medical uses

It is used to treat strep throat, diphtheria, syphilis, and yaws. [3] [5]

Chemopreventive

A single large 1.2-million-unit dose of intramuscular BPG is given to US military recruits. The Army in particular has a policy to inject all recruits if not allergic, though supply issues and individual base choices have reduced the coverage. A retrospective analysis shows that it reduces the rate of all-cause acute respiratory disease by 32% among Army recruits. [10]

Adverse effects

2,400,000 units of Bicillin L-A brand of benzylpenicillin, for deep intramuscular injection Bicillin L-A (Benzylpenicillin).jpg
2,400,000 units of Bicillin L-A brand of benzylpenicillin, for deep intramuscular injection

The possible adverse effects are generally similar to other forms of penicillin. BPG is overall well-tolerated, but pain from the injection site is a common concern. [11]

Benzathine penicillin may cause death through rapid cardiorespiratory arrest if injected intravenously. Onset occurs within seconds or minutes leading to loss of consciousness and cardiac arrest is often asystole. The occurence is rare, but underlying cardiac conditions are a risk factor. [12]

Society and culture

It is marketed by Pfizer (formerly by Wyeth) under the trade name Bicillin L-A. [13]

Compendial status

References

  1. ↑ Hamilton R (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 94. ISBN   9781284057560.
  2. 1 2 Engel J, Kleemann A, Kutscher B, Reichert D, eds. (2009). Pharmaceutical Substances: Syntheses, Patents and Applications of the most relevant APIs (5th ed.). Georg Thieme Verlag. p. 134. ISBN   9783131792754. Archived from the original on 20 December 2016.
  3. 1 2 3 4 5 6 7 8 "Penicillin G Benzathine (Professional Patient Advice) - Drugs.com". www.drugs.com. Archived from the original on 20 December 2016. Retrieved 10 December 2016.
  4. ↑ "Product monograph brand safety updates". Health Canada . 6 June 2024. Retrieved 8 June 2024.
  5. 1 2 3 4 5 6 7 8 World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. pp. 98, 104. hdl: 10665/44053 . ISBN   9789241547659.
  6. ↑ Kirkpatrick T (11 February 2020). "Why the Most Dreaded Injection is Called the 'Peanut Butter' Shot". Military.com. Retrieved 21 December 2021.
  7. ↑ Ebadi M (2007). "Penicillin G". Desk Reference of Clinical Pharmacology (2nd ed.). CRC Press. p. 555. ISBN   9781420047448. Archived from the original on 20 December 2016.
  8. ↑ USpatent 2627491,Szabo JL, Bruce WF,"Penicillin salts of substituted alkylene diamines",published 3 February 1953,issued 3 February 1953, assigned to Wyeth LLCand Wyeth Inc
  9. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  10. ↑ Ball JD, Prosperi MA, Brown A, Chen X, Kenah E, Yang Y, et al. (October 2018). "The role of benzathine penicillin G in predicting and preventing all-cause acute respiratory disease in military recruits: 1991-2017". Epidemiology and Infection. 146 (14): 1854–1860. doi: 10.1017/S0950268818001838 . PMC   9506690 . PMID   29974837.
  11. ↑ Gartlan WA, Rahman S, Reti K (2023). "Benzathine Penicillin". StatPearls. StatPearls Publishing. PMID   29939545.
  12. ↑ Berkovitch M, Ashkenazi-Hoffnung L, Youngster I, Shaniv D, Dil-Nahlieli D, Gorelik E, et al. (2017). "Fatal and Near-Fatal Non-allergic Reactions in Patients with Underlying Cardiac Disease Receiving Benzathine Penicillin G in Israel and Switzerland". Frontiers in Pharmacology. 8: 843. doi:10.3389/fphar.2017.00843. ISSN   1663-9812. PMC   5702457 . PMID   29209214.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  13. ↑ "Bicillin® L-A" (PDF). US FDA. Archived from the original (PDF) on 30 March 2021. Retrieved 31 July 2023.
  14. ↑ 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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