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Factors Associated With Loss of Penicillin G Concentrations in Serum After Intramuscular Benzathine Penicillin G Injection: A Meta-analysis

Broderick, Michael P. PhD*; Hansen, Christian J. BS*; Faix, Dennis J. MD

The Pediatric Infectious Disease Journal: July 2012 - Volume 31 - Issue 7 - p 722–725
doi: 10.1097/INF.0b013e31825051d4
Antimicrobials in Perspective

Background: An interval of 3–4 weeks between intramuscular injections of 1.2 million units of benzathine penicillin G as prophylaxis against group A streptococcal infection is recommended by health organizations for patients with pediatric rheumatic fever and heart disease.

Methods: We reviewed the literature for evidence of the persistence of serum penicillin G during the first 4 weeks after the recommended dose of benzathine penicillin G.

Results: The weighted-mean concentration was <0.02 µg/mL by 3 weeks after the initial dose. Weighted means were lower in studies done after 1990 than before (P < 0.01), in studies dealing with secondary versus primary prophylaxis (P < 0.01) and in studies in children versus those in adults (P < 0.02).

Conclusions: Recommendations for benzathine penicillin G prophylaxis may need reevaluation.

Supplemental Digital Content is available in the text.

From the *Henry M. Jackson Foundation at The Operational Infectious Diseases Department, Naval Health Research Center; and the Operational Infectious Diseases Department, Naval Health Research Center, San Diego, CA.

Accepted for publication February 10, 2012.

This study was supported by the Armed Forces Health Surveillance Center’s Global Emerging Infections Surveillance and Response System. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. The authors have no other conflicts of interest or funding to disclose.

Address for Correspondence: Michael Broderick, PhD, Department of Respiratory Diseases, Naval Health Research Center, San Diego, CA 92106. E-mail:

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© 2012 Lippincott Williams & Wilkins, Inc.