Serum penicillin G levels are lower than expected in adults within two weeks of administration of 1.2 million units
When introduced in the 1950s, benzathine penicillin G (BPG) was shown to be effective in eradicating group A beta-hemolytic streptococcus (GAS) for at least 3 weeks after administration. Several studies since the 1990s suggest that at 3-4 weeks serum penicillin G levels are less than adequate (below...
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| description | When introduced in the 1950s, benzathine penicillin G (BPG) was shown to be effective in eradicating group A beta-hemolytic streptococcus (GAS) for at least 3 weeks after administration. Several studies since the 1990s suggest that at 3-4 weeks serum penicillin G levels are less than adequate (below MIC(90) of 0.016 µg/ml). We studied these levels for 4 weeks after the recommended dose of BPG in military recruits, for whom it is used as prophylaxis against GAS. The 329 subjects (mean age 20 years) each received 1.2 million units BPG IM and gave sera 1 day post injection and twice more at staggered time points over 4 weeks. Serum penicillin G levels were measured by liquid chromatography/tandem mass spectometry. The half-life of serum penicillin G was 4.1 days. By day 11, mean levels were |
| doi_str_mv | 10.1371/journal.pone.0025308 |
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Several studies since the 1990s suggest that at 3-4 weeks serum penicillin G levels are less than adequate (below MIC(90) of 0.016 µg/ml). We studied these levels for 4 weeks after the recommended dose of BPG in military recruits, for whom it is used as prophylaxis against GAS. The 329 subjects (mean age 20 years) each received 1.2 million units BPG IM and gave sera 1 day post injection and twice more at staggered time points over 4 weeks. Serum penicillin G levels were measured by liquid chromatography/tandem mass spectometry. The half-life of serum penicillin G was 4.1 days. By day 11, mean levels were <0.02 µg/ml, and by day 15<0.01 µg/ml. Levels in more than 50% of the subjects were below 0.02 µg/ml on day 9, and <.01 µg/ml on day 16. There was no demonstrable effect of subject body-surface area nor of the four different lots of BPG used. These data indicate that in healthy young adults serum penicillin G levels become less than protective <2½ weeks after injection of 1.2 million units of BPG. The findings require serious consideration in future medical and public health recommendations for treatment and prophylaxis of GAS upper respiratory tract infections.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0025308</identifier><identifier>PMID: 21991307</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Adults ; Antibiotics ; Biology ; Cardiovascular disease ; Chromatography ; Confidence Intervals ; Demography ; Dose-Response Relationship, Drug ; Drug dosages ; Enrollments ; Epidemics ; Health care ; Heart ; Humans ; Infections ; Injection ; Injections, Intramuscular ; Liquid chromatography ; Male ; Medical research ; Medicine ; Military medicine ; Military personnel ; Military training ; Pathogens ; Pediatrics ; Penicillin ; Penicillin G - administration & dosage ; Penicillin G - blood ; Penicillins ; Pharmaceuticals ; Prophylaxis ; Public health ; Respiratory tract ; Respiratory tract diseases ; Streptococcus ; Streptococcus infections ; Surface area ; Young Adult ; Young adults</subject><ispartof>PloS one, 2011-10, Vol.6 (10), p.e25308</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011. This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. 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Several studies since the 1990s suggest that at 3-4 weeks serum penicillin G levels are less than adequate (below MIC(90) of 0.016 µg/ml). We studied these levels for 4 weeks after the recommended dose of BPG in military recruits, for whom it is used as prophylaxis against GAS. The 329 subjects (mean age 20 years) each received 1.2 million units BPG IM and gave sera 1 day post injection and twice more at staggered time points over 4 weeks. Serum penicillin G levels were measured by liquid chromatography/tandem mass spectometry. The half-life of serum penicillin G was 4.1 days. By day 11, mean levels were <0.02 µg/ml, and by day 15<0.01 µg/ml. Levels in more than 50% of the subjects were below 0.02 µg/ml on day 9, and <.01 µg/ml on day 16. There was no demonstrable effect of subject body-surface area nor of the four different lots of BPG used. These data indicate that in healthy young adults serum penicillin G levels become less than protective <2½ weeks after injection of 1.2 million units of BPG. The findings require serious consideration in future medical and public health recommendations for treatment and prophylaxis of GAS upper respiratory tract infections.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Adults</subject><subject>Antibiotics</subject><subject>Biology</subject><subject>Cardiovascular disease</subject><subject>Chromatography</subject><subject>Confidence Intervals</subject><subject>Demography</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug dosages</subject><subject>Enrollments</subject><subject>Epidemics</subject><subject>Health care</subject><subject>Heart</subject><subject>Humans</subject><subject>Infections</subject><subject>Injection</subject><subject>Injections, Intramuscular</subject><subject>Liquid chromatography</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Military medicine</subject><subject>Military personnel</subject><subject>Military training</subject><subject>Pathogens</subject><subject>Pediatrics</subject><subject>Penicillin</subject><subject>Penicillin G - 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Several studies since the 1990s suggest that at 3-4 weeks serum penicillin G levels are less than adequate (below MIC(90) of 0.016 µg/ml). We studied these levels for 4 weeks after the recommended dose of BPG in military recruits, for whom it is used as prophylaxis against GAS. The 329 subjects (mean age 20 years) each received 1.2 million units BPG IM and gave sera 1 day post injection and twice more at staggered time points over 4 weeks. Serum penicillin G levels were measured by liquid chromatography/tandem mass spectometry. The half-life of serum penicillin G was 4.1 days. By day 11, mean levels were <0.02 µg/ml, and by day 15<0.01 µg/ml. Levels in more than 50% of the subjects were below 0.02 µg/ml on day 9, and <.01 µg/ml on day 16. There was no demonstrable effect of subject body-surface area nor of the four different lots of BPG used. 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| subjects | Adolescent Adult Adults Antibiotics Biology Cardiovascular disease Chromatography Confidence Intervals Demography Dose-Response Relationship, Drug Drug dosages Enrollments Epidemics Health care Heart Humans Infections Injection Injections, Intramuscular Liquid chromatography Male Medical research Medicine Military medicine Military personnel Military training Pathogens Pediatrics Penicillin Penicillin G - administration & dosage Penicillin G - blood Penicillins Pharmaceuticals Prophylaxis Public health Respiratory tract Respiratory tract diseases Streptococcus Streptococcus infections Surface area Young Adult Young adults |
| title | Serum penicillin G levels are lower than expected in adults within two weeks of administration of 1.2 million units |
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