Chemistry:Benzathine benzylpenicillin
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| Benzylpenicillin | antibiotic |
| Benzathine | stabilizer |
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| Trade names | Bicillin L-A,[1] Permapen, others |
| Other names | penicillin benzathine benzyl, benzathine penicillin, penicillin G benzathine, benzylpenicillin benzathine[2] |
| AHFS/Drugs.com | Professional Drug Facts |
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| Routes of administration | Intramuscular injection[3] |
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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]
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
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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 occurrence 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
- British Pharmacopoeia[14]
References
- ↑ Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. 2015. p. 94. ISBN 978-1-284-05756-0.
- ↑ 2.0 2.1 (in en) Pharmaceutical Substances: Syntheses, Patents and Applications of the most relevant APIs (5th ed.). Georg Thieme Verlag. 2009. p. 134. ISBN 978-3-13-179275-4. https://books.google.com/books?id=4lCGAwAAQBAJ&pg=PA134.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 "Penicillin G Benzathine (Professional Patient Advice) - Drugs.com". https://www.drugs.com/ppa/penicillin-g-benzathine.html.
- ↑ "Product monograph brand safety updates". 6 June 2024. https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database/label-safety-assessment-update/product-monograph-brand-safety-updates.html.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 WHO Model Formulary 2008. World Health Organization. 2009. pp. 98, 104. ISBN 978-92-4-154765-9.
- ↑ "Why the Most Dreaded Injection is Called the 'Peanut Butter' Shot" (in en). 11 February 2020. https://www.military.com/off-duty/2020/02/10/why-most-dreaded-injection-called-peanut-butter-shot.html.
- ↑ "Penicillin G" (in en). Desk Reference of Clinical Pharmacology (2nd ed.). CRC Press. 2007. p. 555. ISBN 978-1-4200-4744-8. https://books.google.com/books?id=ihxyHbnj3qYC&pg=PA555.
- ↑ Szabo JL, Bruce WF, "Penicillin salts of substituted alkylene diamines", US patent 2627491, published 1953-02-03, issued 1953-02-03, assigned to Wyeth LLCand Wyeth Inc
- ↑ World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. 2019. WHO/MVP/EMP/IAU/2019.06.
- ↑ "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. October 2018. doi:10.1017/S0950268818001838. PMID 29974837.
- ↑ "Benzathine Penicillin". StatPearls. StatPearls Publishing. 2023. https://www.ncbi.nlm.nih.gov/books/NBK507723/.
- ↑ "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. 2017. doi:10.3389/fphar.2017.00843. PMID 29209214.
- ↑ "Bicillin® L-A". US FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/050141s237lbl.pdf.
- ↑ British Pharmacopoeia Commission Secretariat. "Index (BP 2009)". http://www.pharmacopoeia.co.uk/pdf/2009_index.pdf.
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