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"Comparably Massive" Penicillin G Therapy in Renal Failure

CHARLES S. BRYAN, M.D.; and WILLIAM J. STONE, M.D., F.A.C.P.
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Grant support: Veterans Administration General Research Grant; grant TR-74 from the Veterans Administration Infectious Diseases Training Program; and grant HL-08399 from the U.S. Public Health Service.

▸Requests for reprints should be addressed to William J. Stone, M.D., Department of Medicine, Veterans Administration Hospital, Nashville, TN 37203.


Nashville, Tennessee


Ann Intern Med. 1975;82(2):189-195. doi:10.7326/0003-4819-82-2-189
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Impairment of penicillin G excretion in renal failure may result in life-threatening, dose-related toxicity. We report a method for achieving a desired mean serum penicillin G concentration in patients with renal failure, with minimal risk of both undertreatment and drug toxicity. The method is based on the linear relation between the total plasma clearance of penicillin G (Cpen) and the endogenous creatinine clearance. The daily maintenance dose of penicillin G (units) is defined by the product, Cpen (ml/min) X desired mean serum penicillin G concentration (µg/ml) X 2300. Application of this method to patients with various degrees of renal impairment by either constant-rate infusion or intermittent infusion gave serum penicillin G concentrations within the desired range in all but 1 of 15 instances. On the basis of these observations, practical guidelines for "comparably massive" penicillin G therapy are suggested.

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