Improvement in Local Tolerance and Therapeutic Effectiveness of Benzathine Penicillin

Abstract

In β-hemolytic streptococcal infections benzathine penicillin G in doses of between 600,000 to 1,200,000 units has been very effective prophylactically and therapeutically.^1-4 Our own studies⁵ indicate that this drug is superior to any other penicillin preparation we have used in the treatment of such infections in children. The greatest objection to its use is the frequency of markedly painful and sometimes disabling reactions that occur at the site of the injection, which may be sufficient to interfere with walking for several days. Because of these unpleasant reactions many physicians have been loath to use benzathine penicillin. Krugman and Powell⁶ and Krugman and Ebin⁷ used cortisone, fludrocortisone (9-α-fluorohydrocortisone) alcohol, procaine penicillin, and prednisolone as additives to prevent local reaction. They concluded that in children the addition of 5 mg. of cortisone or 2 mg. of fludrocortisone to 600,000 units of benzathine penicillin did not appreciably reduce the