Benzathine benzylpenicillin explained

Benzathine benzylpenicillin, also known as benzathine penicillin G (BPG), is an antibiotic medication useful for the treatment of a number of bacterial infections. Specifically it is used to treat strep throat, diphtheria, syphilis, and yaws. It is also used to prevent rheumatic fever. It is given by injection into a muscle. It is known as "Peanut Butter Shot" in US military slang due to its appearance.[1]

Side effects include allergic reactions including anaphylaxis, and pain at the site of injection. When used to treat syphilis a reaction known as Jarisch-Herxheimer may occur. It is not recommended in those with a history of penicillin allergy or those with syphilis involving the nervous system.[2] Use during pregnancy is generally safe.[2] It is in the penicillin and beta lactam class of medications and works via benzylpenicillin.[2] [3] The benzathine component slowly releases the penicillin making the combination long acting.[4]

Benzathine benzylpenicillin was patented in 1950.[5] [6] It is on the World Health Organization's List of Essential Medicines.[7]

Medical uses

It is used to treat strep throat, diphtheria, syphilis, and yaws.[2] [3]

Chemopreventive

A single large 1.2-million-unit dose of intramuscular BPG is given to US military recruits. The Army in particular has a policy to inject all recruits if not allergic, though supply issues and individual base choices have reduced the coverage. A retrospective analysis shows that it reduces the rate of all-cause acute respiratory disease by 32% among Army recruits.[8]

Adverse effects

See also: Penicillin drug reaction. The possible adverse effects are generally similar to other forms of penicillin. BPG is overall well-tolerated, but pain from the injection site is a common concern.[9]

Society and culture

It is marketed by Pfizer (formerly by Wyeth) under the trade name Bicillin L-A.[10]

Compendial status

Notes and References

  1. Web site: Kirkpatrick T . 11 February 2020. Why the Most Dreaded Injection is Called the 'Peanut Butter' Shot. 21 December 2021. Military.com. en.
  2. Web site: Penicillin G Benzathine (Professional Patient Advice) - Drugs.com. www.drugs.com. 10 December 2016. live. https://web.archive.org/web/20161220230843/https://www.drugs.com/ppa/penicillin-g-benzathine.html. 20 December 2016.
  3. Book: WHO Model Formulary 2008 . 2009 . 9789241547659 . ((World Health Organization)) . Stuart MC, Kouimtzi M, Hill SR . 10665/44053 . World Health Organization . World Health Organization . free . 98, 104 .
  4. Book: Ebadi M . Penicillin G . Desk Reference of Clinical Pharmacology . 2007 . CRC Press. 9781420047448. 555. 2nd . https://books.google.com/books?id=ihxyHbnj3qYC&pg=PA555. en. live. https://web.archive.org/web/20161220152414/https://books.google.ca/books?id=ihxyHbnj3qYC&pg=PA555. 20 December 2016.
  5. Book: Engel J, Kleemann A, Kutscher B, Reichert D . Pharmaceutical Substances: Syntheses, Patents and Applications of the most relevant APIs . 5th . 2009 . Georg Thieme Verlag. 9783131792754. 134 . en. live. https://web.archive.org/web/20161220085328/https://books.google.ca/books?id=4lCGAwAAQBAJ&pg=PA134. 20 December 2016.
  6. US . 2627491 . patent . Penicillin salts of substituted alkylene diamines . 1953-02-03 . 1953-02-03 . 1950-07-15 . 1950-07-15 . Szabo JL, Bruce WF . Wyeth LLC . Wyeth Inc .
  7. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  8. Ball JD, Prosperi MA, Brown A, Chen X, Kenah E, Yang Y, Cummings DA, Rivers CM . The role of benzathine penicillin G in predicting and preventing all-cause acute respiratory disease in military recruits: 1991-2017 . Epidemiology and Infection . 146 . 14 . 1854–1860 . October 2018 . 29974837 . 9506690 . 10.1017/S0950268818001838 . free .
  9. Book: Gartlan WA, Rahman S, Reti K . Benzathine Penicillin . https://www.ncbi.nlm.nih.gov/books/NBK507723/ . StatPearls . StatPearls Publishing . 2023. 29939545 .
  10. Web site: Bicillin® L-A. 31 July 2023. US FDA.
  11. Web site: British Pharmacopoeia Commission Secretariat . Index (BP 2009) . 26 March 2010 . dead . https://web.archive.org/web/20090411071437/http://www.pharmacopoeia.co.uk/pdf/2009_index.pdf . 11 April 2009 .

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