E-drug: Potency of benzathine benzylpenicillin
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Although it is probably premature to suggest intramuscular
Benzathine benzylpenicillin should be abandoned, this study
questions quality of available preparations and suggests a follow-up
to see if the potency of available products have changed. BPG is
not used in Norway - we use oral henoxymethylpenicillin - but I am
thinking of all the BPG products that are urchased by public tenders
in developing countries and their uality..........
[Copied as fair use. KM]
Penicillin Potency Should Be Revisited
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WESTPORT, CT (Reuters Health) Nov 20 - A substantial proportion
of children ith group A streptococcal pharyngitis fail treatment with
recommended doses f oral penicillin V and intramuscular
benzathine penicillin G (BPG), according to findings published in the
November issue of Pediatrics.
Dr. Edward L. Kaplan, of the University of Minnesota Medical
School in Minneapolis, and a colleague present data on 284
children with acute pharyngitis associated with isolation of group A
streptococci, who participated in one of two randomized trials
conducted concurrently in 1994 to 1995. In one study, patients were
assigned to receive ceftriaxone IM or oral penicillin V; in the other,
they received an IM injection of ceftriaxone or BPG. Three followup
visits were scheduled.
Altogether, 35% of the 284 evaluable patients who received oral
penicillin V and 37% of the 271 evaluable patients who received
BPG failed to show microbiologic eradication at one or both of the
later followup visits, 10 to 14 days and 29 to 31 days after the start
of therapy. The researchers point out that the organism should be
eradicated within 9 days in order to most effectively prevent
rheumatic fever.
The findings do not indicate that penicillin should be abandoned as
The first-line treatment for group A streptococcal infections, Dr.
Kaplan stressed in an interview with Reuters Health. In fact, he said,
"penicillin remains, and will remain, the drug of choice for group A
streptococcal infections," because it remains effective and is cheap
and readily available.
Dr. Kaplan further argued that resistance to penicillin is not the
cause of the reduced efficacy of the drug observed in his study. He
told Reuters Health that no resistant strain of group A streptococcus
has ever been reported.
Rather, the findings call into question the potency and quality of
Currently available preparations of penicillin, particularly the
intramuscular form, BPG, according to Dr. Kaplan. He said there is
mounting evidence in the literature that BPG preparations available
today yield lower and less prolonged serum levels of penicillin than
preparations that were available five decades ago.
The next step, Dr. Kaplan said, is to perform additional studies of
the efficacy of penicillin against group A streptococcal infections. In
particular, he would like to see studies conducted using higher
doses of the drug.
"Although not providing sufficient evidence to change current
recommendations for therapy," the authors conclude in the paper,
"the present study raises important questions that require
confirmation, as confirmatory data could significantly impact
currently accepted medical regimens and public health policy
worldwide."
Pediatrics 2001;108:1180-1186.
Kirsten Myhr, MScPharm, MPH
Head of Eastern Region Drug Information Centre
RELIS Ost
Ulleval University Hospital
N-0407 OSLO
Tel: +47 23 01 64 11 Fax: +47 23 01 64 10
kirsten.myhr@relis.ulleval.no (w)
myhr@online.no (h)
www.relis.no
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