Revisions for Penicillin G

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Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication CrCl > 50 mL/min CrCl 10 – 50 mL/min CrCl < 10 mL/min
Neurosyphilis, meningitis, necrotizing SSTI, toxic shock syndrome 4 million units IV q4h 3 million units IV q4h 3 million units IV q6h
Endovascular, bacteremia 3 million units IV q4h 3 million units IV q6h 2 million units IV q6h

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication

Intermittent Hemodialysis

Continuous Hemodialysis

Neurosyphilis, meningitis, necrotizing SSTI, toxic shock syndrome

4 million units IV x1, then 2 million units IV q4h* 3 million units IV q4h
Endovascular, bacteremia 3 million units IV x1, then 2 million units IV q6h 3 million units IV q6h

*Penicillin G Potassium may contain clinically significant amounts of potassium; consider penicillin G sodium instead, if available.

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

References: