Indications & Dose: CHANCROID IM Adult 250mg single dose Child 50mg/kg single dose | COMMUNITY-ACQUIRED PNEUMONIA IV Adult 1g BID/OD | Empirical therapy IV Adult 2g OD with amikacin | CONGENITAL GONOCOCCAL CONJUNCTIVITIS IV Child Neonate: Inf: 25-50mg/kg as single dose, max 125mg over 1h | DISSEMINATED GONOCOCCAL INFECT IV/IM Adult 1g/day for 1 or 2 days followed by oral cefixime/cefpodoxime Child 50mg/kg/day 1 wk, in children weighing <45 kg: 1g/day | ENDOCARDITIS IV/IM Adult 2g/day 4 wk or given with gentamicin 2 wk Child 100mg/kg/day 4 wk | GONORRHEA Uncomplicated IM Adult 125mg as single dose Child <12 yr or <45 kg: 125mg as single dose, 12–18 yr or >45 kg: 250mg as single dose | LYME DISEASE IV Adult 2g OD 2 wks Child 50-75mg/kg/day (up to 2g) 14 days | MENINGITIS Uncomplicated IV Adult 2g BID 1 wk Child Loading dose: 100mg/kg, max 4 g followed by 100mg/kg/day divided q12-24h, max 4g/day 7-14 days. Can also be given by IM | Complicated IV Adult 2g BID 10-14 days Child <45 kg: IV: 50mg/kg/day BID, max 2g/day 10-14days, >45 kg: 1-2g BID 10-14days | OTITIS MEDIA Acute IM Child 50mg/kg as single dose, max 1g | PELVIC INFLAMMATORY DISEASE IM Adult 250mg as single dose plus doxycycline (with or without metronidazole) Child <12 yr or <45 kg: 125mg as single dose, 12–18 yr or >45 kg: 250mg as single dose | PNEUMONIA IV Child 50-75mg/kg/day | SERIOUS INFECT IV Child 80-100mg/kg/day in 1-2 divided doses, max 4g/day | SEXUAL ASSAULT VICTIMS Prophylactic therapy IM Adult 125mg as single dose with metronidazole & azithromycin/doxycycline (PO) Child Same as adult dose | SKIN/SKIN STRUCTURE INFECT IV/IM Child 50-75mg/kg/day in 1-2 divided doses, max 2g/day | SYPHILIS IV/IM Adult 1g OD 10-14days, increased to 2g for neurosyphilis Child Infants < 30 days: 75mg/kg/day 10-14 days, Infants >100 mg/kg 10-14 days | TYPHOID FEVER IV/IM Adult 2-4g OD 3-7 days Child 50-75mg/kg/day 2 wk

Precautions: Penicillin-sensitive patients, history of allergy, renal impairment, false positive Coombs’ test, false Jaffé method of measuring creatinine levels, false-positive reactions for glucose using copper-reduction reactions, concomitant total parenteral nutrition

ADR: Serious: Blood disorders, prolongation of PT, pancreatitis, anaphylaxis, TEN, interstitial nephritis, CNS toxicity, pseudomembranous colitis, thrombophlebitis, transient increases in liver enzyme values, Others: diarrhea, nausea, vomiting, abdominal discomfort, headache, allergic reactions, fever, hallucinations, confusion, hypertonia, dizziness, erythema multiforme

DDI: Serious Diclofenac increases biliary excretion of drug, Aciclovir increases renal toxicity, Amikacin leads to nephrotoxicity, Ciclosporin levels increases

Monitor: Signs & symptoms of anaphylaxis