Congenital syphilis (presence of clinical signs in the neonate and lack of adequate treatment in the mother)
Forms and strengths, route of administration
Powder for injection in vials of:
1 MIU (600 mg), to be dissolved in 2 ml of water for injection or 0.9% sodium chloride
5 MIU (3 g), to be dissolved in 5 ml of water for injection or 0.9% sodium chloride
For IM injection or slow IV injection through an infusion tube (3 to 5 minutes) or infusion(60 minutes) in 0.9% sodium chloride or 5% glucose.
Dosage
Severe leptospirosis
Child: 50 000 IU (30 mg)/kg (max. 2 MIU or 1200 mg) by IV injection every 6 hours
Adult: 1 to 2 MIU (600 to 1200 mg) by IV injection every 6 hours
Neurosyphilis
Adult: 2 to 4 MIU (1200 to 2400 mg) by IV injection every 4 hours
Congenital syphilis
50 000 IU (30 mg)/kg by IV injection every 12 hours from D1 to D7, then
50 000 IU (30 mg)/kg by IV injection every 8 hours from D8 to D10
Duration
Severe leptospirosis: 7 days
Neurosyphilis: 14 days
Congenital syphilis: 10 days
Contra-indications, adverse effects, precautions
Do not administer to penicillin-allergic patients.
Administer with caution to patients allergic to cephalosporins (cross-sensitivity may occur) and renal impairment (reduce dosage in patients with neurosyphilis).
May cause:
gastroinstestinal disturbances, pain at injectionsite, anaemia, allergic reactions sometimes severe;
Jarisch-Herxheimer reaction (fever, chills, myalgia, tachycardia) in patients with syphilis;
convulsions in the event of rapid IV injection, high dosages or renal impairment.
Do not combine with methotrexate.
Pregnancy: no contra-indication
Breast-feeding: no contra-indication
Remarks
Do not confuse short-acting benzylpenicillin, administered several times a day by IV route, with long-acting penicillins (benzathine benzylpenicillin and procaine benzylpenicillin) administered by IM route only.
Do not mix with other drugs in the same syringe or infusion.
Storage
– Below 25 °C
Once reconstituted, suspension must be used immediately.