Bacterial infections:

Indications for BICILLIN C-R:

Susceptible moderately severe infections including respiratory, skin and soft tissue, erysipelas, scarlet fever, otitis media.

Adults and Children:

Give by deep IM inj into upper, outer buttock or anterolateral thigh; for younger children, midlateral thigh may be preferred. Group A strep: <30lbs: 600,000 units; 30–60lbs: 900,000–1.2 million units; >60lbs: 2.4 million units; all as single dose (may split injections) or may give one-half total dose on day 1 and one-half on day 3. Pneumococcal (except meningitis) children: 600,000 units; adults 1.2 million units; give every 2–3 days until afebrile for 48 hrs.

Boxed Warning:

Not for IV use. Do not admix with other IV solutions. Reports of inadvertent IV administration has been associated with cardiorespiratory arrest and death.

Warnings/Precautions:

Not for IV use; do not inject into or near an artery or nerve. History of cephalosporin or significant allergies. Asthma. Increased risk of methemoglobinemia in G6PD deficiency, congenital/idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants <6mos; monitor and discontinue if occurs. Monitor renal and hematopoietic function in prolonged use. Discontinue if superinfection develops. Pregnancy. Nursing mothers.

Pharmacologic Class:

Penicillinase-sensitive penicillin.

Interactions:

Do not admix with other intravenous solutions. Antagonized by concomitant tetracycline; avoid. Potentiated by probenecid. Increased risk of methemoglobinemia with concomitant local anesthetics, acetaminophen, sulfonamides, nitrates, phenytoin, phenobarbital; see full labeling.

Adverse Reactions:

Rash, drug fever, serum sickness, anaphylaxis, blood dyscrasias, neuropathy, nephropathy, inj site reactions, methemoglobinemia, C. difficile-associated diarrhea.

How Supplied:

C-R disposable syringe 600,000 units/mL (2mL)—10 (w. 1 inch or 1.25 inch needles); C-R 900/300 disposable syringe 1.2 million units (2mL)—10 (w. 1 inch needle)