Giuseppe
Emeritus
[Source: PLoS ONE, full text: (LINK). Abstract, edited.]
Serum Penicillin G Levels Are Lower Than Expected in Adults within Two Weeks of Administration of 1.2 Million Units
Michael P. Broderick<SUP>1</SUP><SUP>#*</SUP>, Christian J. Hansen<SUP>1</SUP>, Kevin L. Russell<SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>, Edward L. Kaplan<SUP>4</SUP><SUP>#</SUP>, Jeffrey L. Blumer<SUP>5</SUP><SUP>?</SUP>, Dennis J. Faix<SUP>2</SUP><SUP>#</SUP>
1 Henry M. Jackson Foundation for the Advancement of Military Medicine, Naval Health Research Center, San Diego, California, United States of America, 2 Naval Health Research Center, San Diego, California, United States of America, 3 United States Department of Defense Global Emerging Infections Surveillance and Response System, Silver Spring, Maryland, United States of America, 4 Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America, 5 Departments of Pediatrics and Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
Abstract
When introduced in the 1950s, benzathine penicillin G (BPG) was shown to be effective in eradicating group A beta-hemolytic streptococcus (GAS) for at least 3 weeks after administration. Several studies since the 1990s suggest that at 3?4 weeks serum penicillin G levels are less than adequate (below MIC<SUP>90</SUP> of 0.016 ?g/ml). We studied these levels for 4 weeks after the recommended dose of BPG in military recruits, for whom it is used as prophylaxis against GAS. The 329 subjects (mean age 20 years) each received 1.2 million units BPG IM and gave sera 1 day post injection and twice more at staggered time points over 4 weeks. Serum penicillin G levels were measured by liquid chromatography/tandem mass spectometry. The half-life of serum penicillin G was 4.1 days. By day 11, mean levels were <0.02 ?g/ml, and by day 15<0.01 ?g/ml. Levels in more than 50% of the subjects were below 0.02 ?g/ml on day 9, and <.01 ?g/ml on day 16. There was no demonstrable effect of subject body-surface area nor of the four different lots of BPG used. These data indicate that in healthy young adults serum penicillin G levels become less than protective <2? weeks after injection of 1.2 million units of BPG. The findings require serious consideration in future medical and public health recommendations for treatment and prophylaxis of GAS upper respiratory tract infections.
Citation: Broderick MP, Hansen CJ, Russell KL, Kaplan EL, Blumer JL, et al. (2011) Serum Penicillin G Levels Are Lower Than Expected in Adults within Two Weeks of Administration of 1.2 Million Units. PLoS ONE 6(10): e25308. doi:10.1371/journal.pone.0025308
Editor: Michael Chaussee, University of South Dakota, United States of America
Received: August 4, 2011; Accepted: August 31, 2011; Published: October 4, 2011
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: This work was supported by the Department of Defense Global Emerging Infections Surveillance and Response System, a Division of the Armed Forces Health Surveillance Center, WU# 60501, http://afhsc.mil/geis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: michael.broderick@med.navy.mil
# These authors contributed equally to this work.
? Current address: The University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, United States of America
- ------Michael P. Broderick<SUP>1</SUP><SUP>#*</SUP>, Christian J. Hansen<SUP>1</SUP>, Kevin L. Russell<SUP>2</SUP><SUP>,</SUP><SUP>3</SUP>, Edward L. Kaplan<SUP>4</SUP><SUP>#</SUP>, Jeffrey L. Blumer<SUP>5</SUP><SUP>?</SUP>, Dennis J. Faix<SUP>2</SUP><SUP>#</SUP>
1 Henry M. Jackson Foundation for the Advancement of Military Medicine, Naval Health Research Center, San Diego, California, United States of America, 2 Naval Health Research Center, San Diego, California, United States of America, 3 United States Department of Defense Global Emerging Infections Surveillance and Response System, Silver Spring, Maryland, United States of America, 4 Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America, 5 Departments of Pediatrics and Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
Abstract
When introduced in the 1950s, benzathine penicillin G (BPG) was shown to be effective in eradicating group A beta-hemolytic streptococcus (GAS) for at least 3 weeks after administration. Several studies since the 1990s suggest that at 3?4 weeks serum penicillin G levels are less than adequate (below MIC<SUP>90</SUP> of 0.016 ?g/ml). We studied these levels for 4 weeks after the recommended dose of BPG in military recruits, for whom it is used as prophylaxis against GAS. The 329 subjects (mean age 20 years) each received 1.2 million units BPG IM and gave sera 1 day post injection and twice more at staggered time points over 4 weeks. Serum penicillin G levels were measured by liquid chromatography/tandem mass spectometry. The half-life of serum penicillin G was 4.1 days. By day 11, mean levels were <0.02 ?g/ml, and by day 15<0.01 ?g/ml. Levels in more than 50% of the subjects were below 0.02 ?g/ml on day 9, and <.01 ?g/ml on day 16. There was no demonstrable effect of subject body-surface area nor of the four different lots of BPG used. These data indicate that in healthy young adults serum penicillin G levels become less than protective <2? weeks after injection of 1.2 million units of BPG. The findings require serious consideration in future medical and public health recommendations for treatment and prophylaxis of GAS upper respiratory tract infections.
Citation: Broderick MP, Hansen CJ, Russell KL, Kaplan EL, Blumer JL, et al. (2011) Serum Penicillin G Levels Are Lower Than Expected in Adults within Two Weeks of Administration of 1.2 Million Units. PLoS ONE 6(10): e25308. doi:10.1371/journal.pone.0025308
Editor: Michael Chaussee, University of South Dakota, United States of America
Received: August 4, 2011; Accepted: August 31, 2011; Published: October 4, 2011
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: This work was supported by the Department of Defense Global Emerging Infections Surveillance and Response System, a Division of the Armed Forces Health Surveillance Center, WU# 60501, http://afhsc.mil/geis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: michael.broderick@med.navy.mil
# These authors contributed equally to this work.
? Current address: The University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio, United States of America