PMB500000IU

• Infections of urinary tract, meninges, and bloodstream caused by susceptible strains of Pseudomonas aeruginosa
• H. influenzae (meningeal infections)
• E. coli (urinary tract infections)
• Aerobacter aerogenes (bacteremia)
• Klebsiella pneumoniae (bacteremia)

Adult Dose (Parenteral):

• IV (Susceptible infections): 15,000-25,000 U/kg/day (continuous IV drip or intermittent infusion q12hr, 60-90 min); max 2,000,000 U/day
• IM (Susceptible infections): 25,000-30,000 U/kg/day in divided doses q4-6hr; max 2,000,000 U/day
• Intrathecal (Meningitis): 50,000 U once daily for 3-4 days, then on alternate days for at least 2 weeks after CSF cultures negative and glucose normal

Pediatric Dose (<2 years):

• IV/IM: Max 40,000 U/kg/day
• Intrathecal: 20,000 U once daily for 3-4 days or 25,000 U every other day

Side Effects:

• Nephrotoxicity (albuminuria, cylinduria, azotemia)
• Neurotoxicity (facial flushing, dizziness, ataxia, drowsiness, peripheral paresthesias)
• Apnea (with curariform muscle relaxants, other neurotoxic drugs, or overdosage)
• Signs of meningeal irritation (fever, headache, stiff neck) with intrathecal administration
• Drug fever, urticarial rash
• Severe pain at IM injection sites, thrombophlebitis at IV sites
• Clostridium difficile-associated diarrhea

• Baseline renal function testing; frequent monitoring of renal function and blood levels during parenteral therapy
• Caution in oliguria, myasthenia gravis, pregnancy, renal disease
• Inactivated by strong acidic or alkaline solutions
• Discontinue if diminished urine output, rise in SCr or BUN, or signs of respiratory paralysis
• Do not use IM routinely (especially in children) due to severe injection site pain