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When choosing injectable penicillin for the treatment of group A beta-hemolytic streptococcal pharyngitis, there is a less painful choice


Original Articles

Objective To determine whether injection of patients with Bicillin CR is less painful than injection with Bicillin LA. To discover if Bicillin CR with the addition of procaine, which doubles the volume, causes the injection to be less painful.

Design An experimental, double-blinded crossover design was used for this study.

Setting University children’s and women’s tertiary care emergency Department (ED) with an annual pediatric census of 22,000.

Participants A convenience sample was enrolled from the student body of a large university and house staff, and employees of a 152 bed children’s and women’s hospital in southern Alabama. The sample size was limited to 50 participants, all of whom completed the study.

Methods Each participant received two penicillin injections, one Bicillin CR and one Bicillin LA, and rated the pain of the injection immediately after the injection, 1 hour after the injection and 12 hours after the injection. A visual analogue scale was the tool used for measuring the pain. The penicillin injections were randomized using a random number generator.

Results For each of the three periods, comparisons of pain were made between the Bicillin CR versus Bicillin LA injections. Bicillin LA pain score values were consistently higher for all but the 12-hour comparison. These differences were statistically significant (P < 0.008–0.002).

Conclusions Injection of Bicillin CR with the addition of procaine to the benzathine penicillin G is statistically significantly less painful than the injection of Bicillin LA without the addition of procaine to the benzathine penicillin G, even though the Bicillin LA is one-half the volume of the Bicillin CR due to the addition of procaine to the Bicillin CR.

From Children and Women’s Hospital (T.C. Bycroft), Department of Pediatrics, College of Medicine (T. O’Connor), and College of Nursing (A. Bohannon), University of South Alabama, Mobile, Alabama; and Department of Pediatrics, School of Medicine (C. Hoff), University of Utah, Salt Lake City.

Address for reprints: Theresa C. Bycroft, RN, PNP, Oklahoma State University—College of Osteopathic Medicine, 1111 W. 17th Street, Tulsa, OK 74107-1898; e-mail:

This work was supported by The University of South Alabama’s College of Medicine, Department of Pediatrics.

© 2000 Lippincott Williams & Wilkins, Inc.