Injection Of Procaine Penicillin Research Articles

Un cas de syndrome de Hoigné lors d’une injection intraveineuse de ceftriaxone

IntroductionHoigne's syndrome is characterized by the development of acute clinical manifestations which are mainly psycho-sensorial. Classically, these features immediately follow the injection of procaine penicillin G. Case reportWe report a 59-year-old man who presented with psycho-organic manifestations that occurred just after the intravenous injection of ceftriaxone; to our knowledge, this is the first case of Hoigne's syndrome reported after an injection of this antibiotic. ConclusionThe pathophysiologic basis of this syndrome is still unknown. It is important to keep in mind its clinical characteristics, which may mimic immuno-allergic symptoms. It should be differentiated from anaphylactic manifestations because Hoigne's syndrome allows the continuation of the treatment.

Medical emergencies following dermatological injections and infusions

Emergency situations following appropriately administered injections and infusions are an uncommon dermatologic problem. Embolia cutis medicamentosa is an uncommon complication following intramuscular injection which leads to infarct-like cutaneous necrosis. It may develop after gluteal injection of corticosteroids, anti-inflammatory agents and antibiotics and has rarely been described following venous sclerotherapy with polidocanol. Hoigné syndrome is a pseudoanaphylactic or pseudoallergic reaction following intramuscular injection of procaine penicillin, with neuropsychiatric problems developing immediately after the injection. Subacute forms following intramuscular or oral administration of structurally-related antibiotics. The intraoperative use of patent blue dye has a 1-2% risk of allergic reactions. The patient must be monitored carefully following injection for the onset the life-threatening immediate reaction. Extravasation of cytostatic agents is a critical iatrogenic problem in oncology with an incidence of up to 6.5%. Every oncologic department should have an understanding of necrotic risk of the various agents and an emergency kit with instructions for immediate steps, also including agent-specific antidotes as available.

Platelet Function Defect in a Thoroughbred Filly

A2-year-old Thoroughbred filly presented to the Veterinary Medical Teaching Hospital (VMTH) at the University of California, Davis, for evaluation of a bleeding disorder. The bleeding tendency was 1st noted 3 weeks before presentation on the morning after the horse was pin fired. Prolonged bleeding was noted after intramuscular injection of procaine penicillin G, and the trainer noted blood from the horse's right nostril 2 days before presentation. The filly had been seen by a referral practice, which found a prolonged prothrombin time but no other problems. The horse received an injection of vitamin K intravenously the day before presentation. The current owners purchased the horse ˜1 year before the initial bleeding episode, during which time she had not injured herself or had any intramuscular injections. The filly had received 1 dose PO of a dexamethasone (5 mg) and trichlormethiazide (200 mg) combinationa and 1 or 2 doses of phenylbutazone (unknown amount) but had not received aspirin. The exact dates of administration of these drugs were not known, but they were not within the week before presentation. She had never bled from venipuncture sites

Milk antimicrobial residues in Holstein dairy cattle treated for toxic puerperal metritis

The objective of this study was to determine the presence of antimicrobial agents in milk and the time milk from cows treated for toxic puerperal metritis remained positive for antimicrobial residues. 51 Holstein dairy cows were divided into 3 treatment groups: Group 1 was treated with penicillin; Group 2 was treated with penicillin and tetracycline; and Group 3 was treated with ceftiofur sodium. Cows in Groups 1 and 2 received a daily intramuscular injection of procaine penicillin G at the standard farm-wide dose of 18 million units for 5 consecutive days, nearly 4 times the recommended dose of 3000 U/lb (6600 U/kg). In addition, cows in Group 2 were infused with 6 g of oxytetracycline diluted in 75 ml of sterile water on days 1, 3, and 5. Cows in Group 3 received a daily intramuscular injection of ceftiofur sodium at a standard farm-wide dose of 1 g for 5 consecutive days. Milk samples were collected on day 1, before the first dose of antimicrobial agent was administered, and on days 6 through 12 after the final day of treatment with antimicrobial agents. LacTek B-L (beta-lactam), LacTek TC (tetracycline), and LacTek CEF (ceftiofur) test kits were used to determine penicillin, tetracycline, and ceftiofur sodium residues, respectively, in milk samples. All 3 test kits used in this study have been phased out of production and are no longer available. Milk from 9 of 17 cows treated with penicillin was positive for beta-lactam residues for an average of 3.44 days post-treatment. In a separate group, 6 of 17 cows treated with penicillin were positive for beta-lactam residues for an average of 3.66 days post-treatment. Nine of 17 cows treated with oxytetracycline were positive for tetracycline residues for an average of 1.22 days following treatment. No milk residues were detected in cows treated with ceftiofur sodium. Antimicrobial residues were found in milk from cows treated with penicillin and oxytetracycline for 1 to 7 and 0 to 3 days, respectively, from the last day of treatment. In this study, milk from cows treated with penicillin tested positive for residues longer than expected and longer than the labelled withholding time. Antimicrobial screening may be necessary to prevent food contamination.

Penicillin Residues in Milk Following Subconjunctival Injection of Procaine Penicillin G

Subconjunctival injection of procaine penicillin G is used to treat infectious bovine keratoconjunctivitis. The purpose of this project was to find out how long pencillin can be detected in milk after a single 1 ml bulbar subconjunctival injection of procaine penicillin G.

Effectiveness of intramuscular penicillin versus oral amoxicillin in the early treatment of outpatient pediatric pneumonia

Objective: To determine if intramuscular (IM) penicillin is more effective than oral (PO) amoxicillin in the early outpatient treatment of pediatric patients with presumed bacterial pneumonia. Methods: Prospective, randomized, evaluator-blinded, clinical trial. Setting: Pediatric emergency department (ED) of an urban children's hospital. Patients: ED patients with radiographically confirmed pneumonias managed as outpatients. Patients with chronic illnesses, wheezing, allergy to amoxicillin or penicillin, recent antibiotic therapy, or concurrent diagnosis of another febrile illness were excluded. Interventions: Patients received either a two-day supply of PO amoxicillin (50 mg/kg/day divided tid), or an IM injection of procaine penicillin G (PPG) (50,000 units/kg). They had a complete blood count (CBC), blood culture, and nasopharyngeal swab for viral culture done at initial visit. They returned in 24 to 36 hours for reevaluation. Outcome measures: The main measures were temperature, respiratory rate, and general appearance score; additional measures were accessory muscle use, pulse oximetry, parental report of activity/oral intake. Results: One hundred seventy patients were enrolled. There were no significant differences between the two groups at initial or follow-up visits with respect to temperature, respiratory rate, accessory muscle use, pulse oximetry, or parental reports of activity level and oral intake. Only in the general appearance of children less than two years of age did there appear to be a difference (P= 0.03). When subanalysis excluded patients with positive viral studies (n= 17) or chest x-rays “reread” by an attending pediatric radiologist as “no infiltrate” (n= 29), this difference disappeared (P= 0.10). Three patients in the PO group, and five in the IM group failed by all three main outcome measures (P= 1.00). Four patients in the PO group, and five in the IM group were hospitalized at the follow-up visit (P= 1.00). Conclusion: There does not appear to be a significant difference between PO amoxicillin and IM penicillin in the early outpatient treatment of pediatric patients with presumed bacterial pneumonia.

Effectiveness of intramuscular penicillin versus oral amoxicillin in the early treatment of outpatient pediatric pneumonia

To determine if intramuscular (IM) penicillin is more effective than oral (PO) amoxicillin in the early outpatient treatment of pediatric patients with presumed bacterial pneumonia. Prospective, randomized, evaluator-blinded, clinical trial. Pediatric emergency department (ED) of an urban children's hospital. ED patients with radiographically confirmed pneumonias managed as outpatients. Patients with chronic illnesses, wheezing, allergy to amoxicillin or penicillin, recent antibiotic therapy, or concurrent diagnosis of another febrile illness were excluded. Patients received either a two-day supply of PO amoxicillin (50 mg/kg/day divided tid), or an IM injection of procaine penicillin G (PPG) (50,000 units/kg). They had a complete blood count (CBC), blood culture, and nasopharyngeal swab for viral culture done at initial visit. They returned in 24 to 36 hours for reevaluation. The main measures were temperature, respiratory rate, and general appearance score; additional measures were accessory muscle use, pulse oximetry, parental report of activity/oral intake. One hundred seventy patients were enrolled. There were no significant differences between the two groups at initial or follow-up visits with respect to temperature, respiratory rate, accessory muscle use, pulse oximetry, or parental reports of activity level and oral intake. Only in the general appearance of children less than two years of age did there appear to be a difference (P = 0.03). When subanalysis excluded patients with positive viral studies (n = 17) or chest x-rays "reread" by an attending pediatric radiologist as "no infiltrate" (n = 29), this difference disappeared (P = 0.10). Three patients in the PO group, and five in the IM group failed by all three main outcome measures (P = 1.00). Four patients in the PO group, and five in the IM group were hospitalized at the follow-up visit (P = 1.00). There does not appear to be a significant difference between PO amoxicillin and IM penicillin in the early outpatient treatment of pediatric patients with presumed bacterial pneumonia.

Acceptability and compliance with daily injections of procaine penicillin in the outpatient treatment of syphilis-treponemal infection.

In the United Kingdom, it is recommended that syphilis should be treated with intramuscular daily procaine penicillin with or without oral probenecid for 8 to 21 days. However, it has been argued that this regimen would be unacceptable to patients in terms of daily attendance and volume of drug administered, resulting in poor compliance. To assess the acceptability of and compliance with daily procaine penicillin for 10 to 17 days in patients attending an East London Genito-Urinary Medicine Clinic with a diagnosis of syphilis-treponemal infection. The notes of 210 consecutive patients attending with syphilis-treponemal infection who had been offered treatment with daily procaine penicillin, with or without oral probenecid for 10 to 17 days, were reviewed retrospectively. Of 210 patients who were offered daily procaine penicillin, 42 (20%) declined and were given oral doxycycline, amoxicillin, or depot penicillin injections. Of 168 patients who accepted daily procaine penicillin, depending on the stage of infection, 90 (54%) had 1.8 g of daily procaine penicillin together with oral probenecid 500 mg every 6 hours for 17 days (high-dose regimen), 57 (34%) had 0.6 g of daily procaine penicillin for 10 to 17 days (low-dose regimen), and 21 (12%) had mixed-dose regimens ranging from 0.5 to 2.4 g. Of the 90 who had high-dose regimen, 76 (84%) complied with treatment compared with 50 (88%) of 57 who had low-dose regimen. All 21 patients who had mixed-dose regimens complied fully. Daily procaine penicillin is a well-accepted out-patient regimen with excellent compliance (88% overall) and minimal side effects. Because the high-dose regimen has been shown to achieve treponemicidal levels of penicillin in the cerebrospinal fluid, it is recommended for patients with neurosyphilis or those in whom neurosyphilis cannot be excluded. It also could be considered for patients with concomitant human immunodeficiency virus infection in view of the possible progression to neurosyphilis in those treated with depot penicillin.

Hoigne's syndrome, kindling, and panic disorder.

A review of Hoigne's syndrome (HS) is presented, and 47 cases of putative procaine penicillin-induced HS are discussed within the context of kindling models of human psychopathology. Sixty percent of the individuals with HS in our retrospective study reported a lifetime history of panic disorder. The risk factors and causal relationships among repeated injection of procaine penicillin, HS, and anxiety disorders, particularly panic disorder, require further investigation.

Effect of penicillin or penicillin and dexamethasone in cattle with infectious bovine keratoconjunctivitis

Summary To evaluate the efficacy of penicillin or penicillin and dexamethasone for treatment of infectious bovine keratoconjunctivitis, 6- to 8-month-old beef heifers with clinical signs of infectious bovine keratoconjunctivitis were randomly assigned to 1 of 3 treatment groups: penicillin only, penicillin and dexamethasone, or control. Cattle assigned to the penicillin group (n = 18) were treated with 3 daily subconjunctival injections of procaine penicillin G. Cattle assigned to the penicillin/ dexamethasone group (n = 13) were treated with 3 daily subconjunctival injections of procaine penicillin G and dexamethasone sodium phosphate. Control cattle (n = 14) were not treated. Healing times and frequency of recurrence for corneal ulcers; severity, diameter, and surface area measurements of corneal ulcers; and clinical scores did not differ among the 3 groups. Frequency of Moraxella bovis isolation from specimens of ocular secretions from ulcerated and nonulcerated eyes was similar in all groups. Minimum inhibitory concentration of penicillin G for 95 of the 102 tested M bovis isolates was 0.3 U/ml, and for 7 others was 0.03 U/ml. When first and last specimens from 42 of 45 calves with isolation of M bovis on serial microbial cultures were compared, the susceptibility of each last isolate was similar to that of the corresponding first isolate.

The concentration of penicillin in bovine conjunctival sac fluid as it pertains to the treatment of Moraxella bovis infection. (I) Subconjunctival injection.

Single dose, subconjunctival injections of procaine penicillin using either skin or conjunctival routes of administration were evaluated in order to compare the duration of antibacterial concentrations at the site of Moraxella bovis infection. Samples of conjunctival sac fluid (CF) were collected using blunted capillary tubes and were periodically assayed for penicillin by an agar-well-diffusion technique. Linear regression lines were constructed for concentration of penicillin-time profiles. Similarity of the regression slopes for each treatment enabled the construction of three common lines by the method of co-variance analysis in order to represent each treatment. Treatments were thereafter compared by the slopes of the common regression lines. A subconjunctival injection of procaine penicillin at a dose of 6 X 10(5) iu in 2 ml, administered either through the skin or through the conjunctiva, produced a peak penicillin concentration in the CF of approximately 8 iu/ml for either route and a duration of therapeutic concentration (DTC) of 67.6 +/- 4.9 and 40 +/- 2.7 h respectively. A dose of 3 X 10(5) iu in 1 ml, administered through the conjunctiva, produced a similar peak but the DTC was reduced to 35 +/- 4.2 h. The results of this study support field practices, as adequate penicillin concentrations were maintained by both techniques investigated.

Adverse reaction to procaine penicillin G in horses

Adverse reactions to intramuscular injections of procaine penicillin G are reported in 11 horses, five of which died. The clinical findings are presented and suggest central nervous involvement in most cases. Post mortem findings in one horse were consistent with anaphylaxis whereas in other cases the clinical findings, duration of treatment, speed of onset and subsequent completion of treatment supports diagnosis of an acute procaine toxicity syndrome.

Inapparent Intravenous Procaine-Reply

In Reply .—Colonel Weir questions whether a true intramuscular injection could ever cause Hoigne's syndrome or whether this syndrome is actually provoked by inadvertent intravascular injection. The intramuscular route remains a possibility. Once in the organism, procaine and penicillin are rapidly separated by procaine esterase. The level of plasma procaine has been shown to be significantly raised immediately following the intramuscular injection of procaine penicillin (being undetectable only 30 minutes later). 1 However, there is no question that in at least some instances inadvertent intravascular injection may be responsible for the symptomatology. To support this viewpoint one can cite patients complaining about the taste of medication almost immediately after the injection. 2 Moreover, patients with cardiovascular insufficiency seem to constitute a risk group for the condition, 3 suggesting the possibility of embolic phenomena. Indeed, anxiety, tinnitus, visual difficulty, and paresthesias have been described secondary to fat emboli, and therefore it

PENICILLIN PROPHYLAXIS (PP) FOR EXPERIMENTAL STREPTOCOCCAL ENDOCARDITIS IS EARLY PENICILLIN TREATMENT

The aim of PP for endocarditis due to viridans streptococci (VS) is to prevent the onset of bacteremia. However, the incidence of postextraction bacteremia in children with cardiac disease after dental extraction under PP has been shown to be 21% (Hess et al, Ped 71: 554-558, 1983). Since the adherence of VS onto vegetations is recognized as an initial step in the pathogenesis of endocarditis, we studied the effect of P on adherence of VS in experimental endocarditis. 107-CFU penicillin-sensitive VS (MIC .01μg/ml, MBC .02μg/ml) were injected iv 30 min after im injection of procaine penicillin G (PPG) 250 mg/kg into Chinchilla rabbits with a left heart catheter in situ for 24 hrs. The rabbits were sacrificed 5 min, 0.5 hr, 2 hr, 4 hr and 48 hr after the injection of the VS, and the cardiac vegetations, induced by the catheter, were excized and cultured to determine whether or not colonization of the vegetations had been prevented by P. Results were: We conclude that PP does not prevent the colonization of cardiac vegetations by reducing the bacterial adherence, but sterilizes initially infected vegetations. Therefore, PP for experimental streptococcal endocarditis is in fact early treatment.

Intramuscular treatment of subclinical staphylococcal mastitis in lactating cows with penicillin G, methicillin and their esters.

The relationship between antibiotic milk concentrations and bacteriological efficacy was investigated in groups of lactating cows with subclinical mastitis due to either penicillin G-sensitive or penicillin G-resistant Staphylococcus aureus. Treatments consisted of the intramuscular injection of procaine penicillin G, or its weak base ester penethamate hydriodide, and sodium methicillin, or its weak base ester tamethicillin. Antibiotics were administered once daily for 2 or 4 days at accepted dosages. After four daily, treatments with procaine penicillin G and penethamate hydriodide, infections were eliminated from 56.5% and 68.8%, respectively, of quarters infected with penicillin G-sensitive staphylococci, and from 14.3% and 7.7%, respectively, of quarters infected with penicillin G-resistant staphylococci. After four daily treatments with sodium methicillin and tamethicillin, infections were eliminated from 32.4% and 48.6%, respectively, of quarters infected with penicillin G-resistant staphylococci. The better efficacy of penethamate hydriodide and tamethicillin was considered to be linked to the higher milk drug concentrations obtained with these drugs as opposed to the lower concentrations measured in the milk after treatment with the parent drugs. Cure rates were generally higher after treatment for 4 days than after the 2-day course of therapy. Treatment efficacy decreased progressively with increasing age of the cows. Intramuscular treatment of subclinical staphylococcal mastitis in lactating cows can serve as a useful model for screening existing and new antibacterial agents and drug products intended for the parenteral treatment of clinical staphylococcal mastitis.

Procaine penicillin by subconjunctival injection in the treatment of infectious bovine keratoconjunctivitis

A profile off the penicillin concentration in bovine conjunctival sac fluid (CF) was determined after a single subconjunctival injection of procaine penicillin (6 x 10(5) iu in 2ml). When the injection was made through the skin of the upper eye lid, the duration of therapeutic concentration was significantly greater (P<0.01) than when the injection had been given by the perconjunctival route: approximately 68 hours or 40 hours respectively. These findings support the clinical use of subconjunctivally administered procaine penicillin in the treatment of infectious bovine keratoconjunctivitis. A single application of an equivalent dose of either procaine penicillin or benethamine penicillin, applied topically in a simple occulentum base, produced a therapeutic duration in CF of 37 +/- 4 hr and 56 +/- 4.5 hr respectively.

Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injection of aqueous procaine penicillin 0.6 MU with and without probenecid.

Paired specimens of cerebrospinal fluid and serum were taken from 21 patients to estimate penicillin concentrations two to three hours after the last dose of a course of 14-21 daily intramuscular injections of procaine penicillin 0.6 MU. Of 10 patients treated with procaine penicillin alone, eight had no detectable penicillin and two had sub-treponemicidal concentrations (less than 0.018 mg/l) in the cerebrospinal fluid. Of 11 patients treated with procaine penicillin as above and probenecid 2 g a day by mouth, three had no detectable penicillin, two had sub-treponemicidal concentrations, and six had treponemicidal concentrations of penicillin in the cerebrospinal fluid. All 21 patients had treponemicidal concentrations of penicillin in the serum. This dose of procaine penicillin alone or with probenecid is therefore not recommended for treating neurosyphilis.

Psychotic-like reaction to procaine penicillin G

A patient developed a psychotic-like reaction immediately after receiving an intramuscular injection of procaine penicillin G. The patient complained of a metallic taste, dizziness, ringing of the ears, and the fear of imminent death. No cardiovascular or pulmonary disturbances were noted. The reaction and all symptoms resolved within 15 minutes, and the patient has reported no further episodes. The case and a review of the literature are presented.

Hoigné's syndrome — its course and symptomatology

The study presents the clinical symptomatology of acute embolic-toxic reactions to penicillin seen in 9 patients treated with the drug. The complex of short-lasting symptoms characterized by severe agitation with confusion, visual and auditory hallucinations and dire fear is caused by accidental penetration of an amount of intramuscular penicillin injected into the venous system. The authors' experience and the data so far published reveal a much more frequent occurrence of Hoigné's (1959) syndrome than is usually thought. The syndrome does not depend upon the dose of a single injection of procaine penicillin but it may be attributed to poor technique of intramuscular injection and to great number of injections in a small area of the buttock. It is recommended that intravenous steroids in the treatment of acute symptoms of Hoigné's syndrome beside pharmacological sedation of the patient are applied.

Penicillin-Sensitive Gonococci and Polyarthritis

For those senior investigators who helped introduce depot penicillin into clinical practice, the article in this issue ofThe Journalby Trentham and colleagues (p 2410) on the treatment of gonococcal arthritis is particularly gratifying. When penicillin G was more expensive and intravenous therapy less routine, the demonstration of the levels in the blood achieved by injections of procaine penicillin G was of great interest, especially when such levels were far in excess of the penicillin sensitivity of such organisms as group A streptococci,Treponema pallidum, pneumococci, and gonococci.1,2 Proceeding on the assumption of the continued sensitivity of gonococci which produce bacteremia and arthritis, some of us who needed to differentiate the syndrome of gonococcal polyarthritis from acute rheumatic fever in an adolescent population in which both diseases were prevalent found that a therapeutic trial of 600,000 units of procaine penicillin G daily was very useful. Such therapy seemed