Indications & Dose: ACTINOMYCES SPECIES Adult 10-20MU/day in divided doses q4-6h 4-6 wk | BRAIN ABSCESS Combination therapy IV Adult 18-24MU/day in divided doses q4h with metronidazole | CONGENITAL SYPHILIS IV Child Infants: 50, 000U/kg q12h for first 7 days of life, then q8h next 10 days, Children: 50, 000 U/kg q4-6h 10 days | DIPHTHERIA IV Adult 2-3MU/day in divided doses q4-6h 10-12 days | ENDOCARDITIS IV Adult 3-4MU q4h at least 4wk Child 1 month–18 yr: 25mg/kg q4h, increased to 50mg/kg, max 2.4g q4h | FASCIAL SPACE INFECT Combination therapy IV Adult 2-4MU q4-6h with metronidazole | LYME DISEASE IV Adult 20MU/day in divided doses | MENINGITIS IV Child Neonate:75mg/kg q8h, 1 month–18 yr: 50mg/kg q4–6h, max 2.4g q4h | MILD-MODERATE SUSCEPTIBLE INFECT IV Child >7 days: 25mg/kg q12h, 7–28days: 25mg/kg q8h, 1 month–18 yr: 25mg/kg q6h | NEUROSYPHILIS IV Adult 18-24MU/day q4h 10-14 days Child 200, 000-300, 000U/kg/day q4-6h 10-14 days, max 24MU/day | OSTEOMYELITIS IV Adult 3-4MU q4h 4wk | PNEUMONIA IV Adult 2-3MU q4h | SEVERE INFECT IV Child >7 days: 50mg/kg q12h, 7–28 days: 50mg/kg q8h, 1 month–18 yr: 50mg/kg q4–6h, max 2.4g q4h | SKIN & SOFT TISSUE INFECT IV Adult 3-4MU q4h 10 days

Precautions: Renal/hepatic impairment, seizures, asthma

ADR: Serious: coma, seizures, hyperreflexia, neutropenia, positive coombs hemolytic anemia, renal tubular damage, interstitial nephritis, myoclonus, anaphylaxis, Others: Jarisch-herxheimer reaction, hypersensitivity reactions, electrolyte imbalance, dermatitis, rash, thrombophlebitis

Diet:

Monitor: Periodic electrolyte, LFT, RFT, cardiac & hematologic function test during prolonged/high-dose therapy, signs & symptoms of anaphylaxis