Inhibiting ability of benzathine penicillin G towards group A Streptococcus β -hemolyticus in 21 and 28 days after a single intramuscular injection

Background The effectiveness of a single intramuscularbenzathine penicillin G as a secondary prevention of acute rheu-matic fever after 28 days is still controversial. The latest studyshowed that serum penicillin concentration was below protectivelevel in 4 weeks after a single intramuscular injection.Objective This study was a preliminary study to compare the in-hibiting ability of benzathine penicillin G towards group A Strepto-coccus β -hemolyticus in 21 and 28 days after a single IM injectionby using Mueller-Hinton broth method.Methods The inhibiting ability was measured by the serum in-hibitory concentration and serum bactericidal concentration aftera single intramuscular injection of benzathine penicillin G 1.2 mil-lion units.Results The subjects were 28 patients, with mean age of 15.5years (SD 3.4). The numbers of male and female were equal. Meanserum inhibitory concentration in 21 days after a single injectionwas 926.4 (SD 3080.1) and after 28 days was 1540.9 (SD 4275.1),which was not significantly different (p=0.0662). Mean serum bac-tericidal concentration in 21 days after IM injection was 1579.6(SD 4265.7) and in 28 days was 2417 (SD 6849.4) and it was notstatistically different (p=0.2276).Conclusion This study concluded that there was no significantdifference in the inhibiting ability of benzathine penicillin G to-wards group A Streptococcus β -hemolyticus between 21 and 28days after a single intramuscular injection

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Rheumatic Fever Article Questioned

PEDIATRICS ◽

10.1542/peds.74.6.1133a ◽

1984 ◽

Vol 74 (6) ◽

pp. 1133-1134

Author(s):

SYLVIA P. GRIFFITHS

Keyword(s):

Rheumatic Fever ◽

Intramuscular Injection ◽

Group A Streptococcus ◽

Penicillin G ◽

Benzathine Penicillin ◽

Benzathine Penicillin G ◽

Group A

To the Editor.— The suggestion of Nordin1 that there may be a need to re-evaluate the current recommended prophylaxis for children with rheumatic fever is valid, particularly if carefully planned and controlled studies could be carried out. However, the author's contention that "It has been assumed that the levels of penicillin [following monthly intramuscular injection of 1.2 million units of benzathine penicillin G] are adequate to prevent reinfection with group A streptococcus, and hence to prevent recurrences of rheumatic fever" has always been qualified by others.

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Rheumatic Fever & Rheumatic Heart Disease: Azithromycin Must Replace Penicillin for Treatment and Prophylaxis

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v12i2.14476 ◽

2016 ◽

Vol 12 (2) ◽

pp. 42-45 ◽

Cited By ~ 1

Author(s):

Arati Lalchandani ◽

Senthi Raj ◽

M. Godara ◽

V. Singh ◽

A. Kumar ◽

...

Keyword(s):

Group A Streptococcus ◽

Low Cost ◽

Secondary Prophylaxis ◽

Sensitivity Test ◽

Penicillin G ◽

Benzathine Penicillin ◽

Benzathine Penicillin G ◽

Daily Dose ◽

Group A ◽

Rheumatic Heart

The standard and age-old treatment of RF/ RHD is a single injection of Benzathine Penicillin G given intramuscular after sensitivity test in a dose of 1.2 million units. For secondary prophylaxis, this is followed by Injection Benzathine Penicillin given intramuscular, each time after sensitivity test, after every 21 days (3weeks), in the same dose of 1.2 million units. The treatment and prophylaxis of RF/ RHD has never seriously been reviewed in the light of newer drugs discovered for GAS (Group A Streptococcus) after Penicillin. All the other drugs mentioned above are oral forms which could never be an alternative to Benzathine Penicillin due to the daily dose required, except for Azithromycin which has a long half-life and several other pharmacological properties which make it an ideal drug for treatment and prophylaxis of RF/ RHD. Benzathine Penicillin G is in use for past 60 years due to convenience of dosing, its undoubted efficacy in eradication of the GABHS, and the low cost. But the scene is changed now.JNGMC Vol. 12 No. 2 December 2014, Page: 42-45

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Activity of Amikacin, Gentamicin and Kanamycin against Pseudomonas Aeruginosa

Journal of International Medical Research ◽

10.1177/030006057600400304 ◽

1976 ◽

Vol 4 (3) ◽

pp. 165-175 ◽

Cited By ~ 2

Author(s):

Jose Ximenes ◽

Orlando Natale Bassoi ◽

Jairo Perche de Menezes ◽

Wilson Fry

Keyword(s):

Pseudomonas Aeruginosa ◽

Half Life ◽

Intramuscular Injection ◽

Saline Solution ◽

Serum Levels ◽

Post Dose ◽

Mueller Hinton ◽

Single Intramuscular Injection ◽

Mueller Hinton Broth

The activity of amikacin, gentamicin and kanamycin was tested in vitro against clinical isolates of Pseudomonas aeruginosa. Concentrations of the antibiotics in serum and in saline solution were prepared according to serum levels produced in volunteers 15 minutes, 1, 2, and 6 hours after a single intramuscular injection of 500 mg amikacin, 80 mg gentamicin and 500 mg kanamycin. Following isolation of the Pseudomonas strains in cultures, they were incubated and seeded in Mueller-Hinton broth, then 107 dilutions of the organisms were kept in contact with the prepared antibiotic solutions in serum and in saline solution for three hours, the approximate half-life of the antibiotics in serum. Amikacin was active at concentrations seen six hours post-dose, inhibiting growth in a total of 72·5% of seeded plates. Gentamicin was active for only two hours and inhibited growth in 2·5% of the plates. Kanamycin showed no anti-pseudomonal activity.

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Pharmacokinetics of benzathine penicillin G: Serum levels during the 28 days after intramuscular injection of 1,200,000 units

The Journal of Pediatrics ◽

10.1016/s0022-3476(89)80352-x ◽

1989 ◽

Vol 115 (1) ◽

pp. 146-150 ◽

Cited By ~ 35

Author(s):

Edward L. Kaplan ◽

Ximena Berrios ◽

John Speth ◽

Thomas Siefferman ◽

B. Guzman ◽

...

Keyword(s):

Intramuscular Injection ◽

Serum Levels ◽

Penicillin G ◽

Benzathine Penicillin ◽

Benzathine Penicillin G

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Rheumatic Fever Prophylaxis Using Benzathine Penicillin G (BPG): Two-week Versus Four-week Regimens: Comparison of Two Brands of BPG

PEDIATRICS ◽

10.1542/peds.97.6.992 ◽

1996 ◽

Vol 97 (6) ◽

pp. 992-995

Author(s):

Ahmed Samir Kassem ◽

Salah R. Zaher ◽

Hamida Abou Shleib ◽

Abdel Ghany El-Kholy ◽

Ahmed A. Madkour ◽

...

Keyword(s):

Rheumatic Fever ◽

Recurrence Rate ◽

Penicillin G ◽

Diffusion Method ◽

High Recurrence Rate ◽

Benzathine Penicillin ◽

Benzathine Penicillin G ◽

Group A ◽

Upper Respiratory ◽

The Difference

Objective. This prospective study was aimed at answering two important questions: 1) Is a biweekly schedule of 1.2 million U intramuscular benzathine penicillin G (BPG) superior to a 4-week one in the prevention of upper respiratory Group A beta-hemolytic streptococcal (GABHS) infections and rheumatic fever (RF) recurrences? 2) Is there a difference in the bioavailability of BPG obtained from different manufacturers? Methodology. Three hundred sixty rheumatic patients aged 4 to 20 years were randomly assigned to either a biweekly (190 patients) or 4-week (160 patients) BPG prophylactic schedule and were followed-up monthly for 2 years by clinical examination, throat swab culture for GABHS and measurement of antistreptolysin O titer to detect GABHS infection and/or recurrences of RF (according to revised Jones' Criteria). Thereafter, 34 rheumatic subjects, aged 8 to 16 years were randomly assigned to receive a 4-week injection of 1.2 million U of either a locally manufactured BPG brand (22 patients) or an imported one (12 patients). Sera of all patients were tested for penicillin level by plate diffusion method on days 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28 after the intramuscular injection of BPG. Results. The GABHS infection rate was found to be 0.2% and 0.3% for patients on the biweekly and 4-week BPG schedules, respectively, with no significant differences between them. However, the RF recurrence rate/patient/year for the 4-week schedule patients (0.12) was double that for the biweekly schedule ones (0.06). Estimation of the bioavailability of the two different brands of BPG demonstrated a difference in their pharmacokinetics and a decrease in the serum penicillin concentration below the minimum inhibitory concentration 3 weeks after the injection of either brand. Conclusion. Although a biweekly schedule may not be superior in preventing upper respiratory GABHS infection, it may play a role in preventing the sequelae of such infections. The short duration of penicillinemia explains the superiority of the 2-week schedule in RF prophylais. The difference in the pharmacokinetics of penicillin brands might contribute to the high recurrence rate of RF reported in Egypt.

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USE OF BENZATHINE PENICILLIN G IN CARRIERS OF GROUP A BETA-HEMOLYTIC STREPTOCOCCI

Journal of the American Medical Association ◽

10.1001/jama.1956.02960380010004 ◽

1956 ◽

Vol 160 (3) ◽

pp. 162 ◽

Cited By ~ 14

Author(s):

Thomas J. Brooks

Keyword(s):

Penicillin G ◽

Benzathine Penicillin ◽

Benzathine Penicillin G ◽

Group A

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A COMPARISON OF ORAL BENZATHINE PENICILLIN G AND SULFONAMIDES FOR THE PREVENTION OF STREPTOCOCCAL INFECTIONS AND RECURRENCES OF RHEUMATIC FEVER

PEDIATRICS ◽

10.1542/peds.15.5.509 ◽

1955 ◽

Vol 15 (5) ◽

pp. 509-515

Author(s):

Milton Markowitz ◽

Woodrow Hemphill

Keyword(s):

Rheumatic Fever ◽

Significant Rise ◽

Penicillin G ◽

Streptococcal Infections ◽

Benzathine Penicillin ◽

Number Of Patients ◽

Benzathine Penicillin G ◽

Daily Dose ◽

Group A ◽

Toxic Reactions

1. The incidence of recurrences of rheumatic fever and streptococcal infections in 82 rheumatic subjects receiving a 200,000 unit tablet of benzathine penicillin G daily was compared with that in 64 rheumatic patients on a standard daily dose of a triple sulfonamide preparation, while both groups were followed for an average period of 13 months. 2. A total of 9 recurrences of rheumatic fever was noted, 4 in the group treated with penicillin and 5 among patients on sulfonamides. 3. The incidence of streptococcal infections as determined by a significant rise in the antistreptolysin O titer was essentially the same in both groups. Group A streptococci were found in the throat in about the same number of patients in each group. 4. Toxic reactions of a mild nature were noted in 7 patients (11 per cent) receiving sulfonamides as compared to 2 patients (2.5 per cent) on oral penicillin. 5. A single daily dose of 200,000 units of benzathine penicillin G is as effective a prophylactic agent as the sulfonamides for the prevention of rheumatic fever. Its chief advantage is the lower incidence of toxic reactions.

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