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 (dorsogluteal) or ventrogluteal site; 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 48hrs.
Not for IV use. Do not admix with other IV solutions. Reports of inadvertent IV administration has been associated with cardiorespiratory arrest and death.
BICILLIN C-R Warnings/Precautions:
Not for IV use; do not inject into or near an artery or nerve. Risk of femoris necrosis and atrophy with IM injs into the anterolateral thigh; not recommended. History of cephalosporin or significant allergies. Discontinue if severe cutaneous adverse reaction (eg, SJS, TEN, DRESS, AGEP) is suspected; consider alternative therapy. 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. Elderly. Pregnancy. Nursing mothers.
BICILLIN C-R Classification:
BICILLIN C-R 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, cyclophosphamide; see full labeling.
Rash, drug fever, serum sickness, anaphylaxis, blood dyscrasias, neuropathy, nephropathy, inj site reactions, methemoglobinemia, C. difficile-associated diarrhea; severe cutaneous adverse reactions.
C-R disposable syringe 600,000 units/mL (2mL)—10 (w. 1 inch or 1.5 inch needles); C-R 900/300 disposable syringe 1.2 million units (2mL)—10 (w. 1 inch needle)