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Sexually Transmitted Diseases > Alternatives to intravenous penicillin G for specific infections
Update: August
22, 2005 -
Dear Colleague Letter - This letter outlines
procedures for securing supplies of King’s Bicillin® L-A for the
management of infectious syphilis in the United States
Update: September, 2000 - Penicillin G Availability - FDA (Food and Drug Administration) personnel indicated intravenous penicillin G is generally available. Alternatives to intravenous penicillin G for specific infections A recent product recall and decreased production have caused a shortage of aqueous penicillin G. Existing supplies should be used for persons for whom alternative antibiotics would not be appropriate. There are relatively few conditions for which aqueous penicillin G is considered the treatment of choice. These include congenital syphilis, neurosyphilis, and intrapartum group B streptococcus prophylaxis. Alternative recommendations for these conditions are given below. CONGENITAL SYPHILIS (CS) CDC's 2002 Treatment Guidelines 1. recommend treating infants with CS with intravenous (IV) aqueous penicillin G or intramuscular (IM) procaine penicillin G. Physicians often use IV penicillin G for children at risk for congenital syphilis, or with clinical evidence of infection. During this shortage, CDC and the American Academy of Pediatrics recommend:
NEUROSYPHILIS CDC's 2002 Treatment Guidelines 1 recommend treating persons with neurosyphilis and persons with neurologic involvement with syphilis with IV aqueous penicillin G. For persons in whom compliance with therapy can be ensured, an alternative treatment regimen of IM procaine penicillin G is included in the 2002 Guidelines. During this shortage of aqueous penicillin G, CDC recommends the following:
Some experts administer benzathine penicillin, 2.4 million units IM once per week for up to three weeks, after completing a neurosyphilis treatment regimen to provide a duration of therapy that is comparable to the treatment regimen for late syphilis in the absence of neurosyphilis. HIV-infected persons with neurosyphilis should be treated in the same manner as persons who are not HIV-infected. Recommended follow-up of HIV-infected persons includes more frequent visits over a longer duration of time than persons who are not HIV-infected. 1 GROUP B STREPTOCOCCUS (GBS) PROPHYLAXIS In collaboration with ACOG, AAP, and a multi-disciplinary panel of experts, CDC has developed guidelines for preventing perinatal GBS disease. 3 These guidelines include offering intrapartum antibiotic prophylaxis to women in whom GBS carriage has been demonstrated and to particular groups of women with elevated risk of delivering children who develop GBS infection. IV penicillin G has often been used as prophylaxis. During this shortage of aqueous penicillin G, CDC recommends using IV ampicillin for GBS prophylaxis. The recommended dose is a loading dose of 2g and 1g IV every four hours until delivery.
To receive this document by fax, call CDC's Fax Information Service, at 888-CDC-FAXX (888-232-3299) and request document #210007. Page last modified: August 22, 2005 Page last reviewed: August 22, 2005 Historical Document Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention |
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