20 to 50     : Dose as in normal renal function
10 to 20     : 600 mg – 2.4 g every 6 hours depending on severity of infection
<10           : 600 mg – 1.2 g every 6 hours depending on severity of infection
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Dialysed. Dose as in GFR <10 mL/min
HD                     :Dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Dialysed. Dose as in GFR <10 mL/min
CAV/VVHD      :Dialysed. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsReduced excretion of methotrexate
ADMINISTRATION
Reconstition
IV Bolus: 600 mg in 5 mL water for injectionIV Infusion: 600 mg in at least 10 mL sodium chloride 0.9%
IM: 600 mg in 1.6 mL water for injection 600 mg displaces 0.4 mL
Route
IV Bolus, IV Infusion, IM
Rate of Administration
IV bolus: over 3–4 minutes
IV infusion
: over 30–60 minutes
Comments
IV doses in excess of 1.2 g must be given slowly at minimum rate of 300 mg/minute
OTHER INFORMATION
Dose in normal renal function: meningitis up to 14.4 g daily; bacterial endocarditis 4.8 g daily
Maximum dose in severe renal impairment: 4.8 g per day600 mg of benzylpenicillin sodium (1 mega unit) contains 1.68 mmol of sodium600 mg of benzylpenicillin potassium contains 1.7 mmol potassium
Increased incidence of neurotoxicity in renal impairment (seizures)
False positive urinary protein reactions may be caused by benzylpenicillin therapy