Infectious Disease Compendium

Penicillin Desensitization

A penicillin desensitization protocol we use in my system. The only time this would be used is to treat syphilis.

Desensitization Protocol for penicillin G 4 million unit dose administration

Dilution Procedure: Solution 1:

  • Reconstitute 5 million unit vial to 250,000 units/mL

  • Draw out 0.2 mL

  • Inject into 250 mL bag NS

  • Label as Solution 1 Solution 2:

  • Reuse 5 million unit vial from Solution 1

  • Draw out 1.6 mL

  • Inject into 250 mL bag NS

  • Label as Solution 2 Solution 3:

  • Reconstitute 5 million unit vial to 1 million units/mL

  • Draw out 4 mL

  • Inject into 250 mL bag NS

  • Label as Solution 3

    Penicillin G 4 million Units IV induction of tolerance /desensitization

    Full Dose

    Total mg to be Injected in Each Bottle

    Concentration n

    (units/ mL)

    Solution 1

    250

    mL

    50,000 units

    200

    Solution 2

    250

    mL

    400,000 units

    1,600

    Solution 3

    250

    mL

    4,000,000 units

    16,000

    Steps for protocol

    Ste p

    Solution

    Rate (mL/h)

    Time (min)

    Administered Dose (units)

    Cumulative Dose (units)

    1

    1

    2

    15

    100

    100

    2

    1

    5

    15

    250

    350

    3

    1

    10

    15

    500

    850

    Ste p

    Solution

    Rate (mL/h)

    Time (min)

    Administered Dose (units)

    Cumulative Dose (units)

    4

    1

    20

    15

    1,000

    1,850

    5

    2

    5

    15

    2,000

    3,480

    6

    2

    10

    15

    4,000

    7,480

    7

    2

    20

    15

    8,000

    15,480

    8

    2

    40

    15

    16,000

    31,480

    9

    3

    10

    15

    40,000

    71,480

    10

    3

    20

    15

    80,000

    151,480

    11

    3

    40

    15

    160,000

    311,480

    12

    3

    80

    173

    3,688,520

    4,000,370

    Total time = 337.9 min (5 h 63 min)

    NOTE: Each step is administered over 15 minutes. At conclusion of protocol, observe pa;ent for 30 minutes. Next dose can be full therapeutic dose given by the desired route.

    Desensitization protocol instructions: Prime tubing with contents of Solution 1

    1. Confirm written consent is in medical record.

    2. Ensure preceding dose of beta-­‐blocker was held, unless otherwise advised.

    3. Obtain IV access, and vital signs (temp, HR, BP, RR, oxygen saturation, peak flow).

    4. Have at bedside: Epi-­‐pen, oxygen, normal saline, peak flow meter and BP cuff, albuterol, IV diphenhydramine, and methylprednisolone.

    5. A nurse must closely observe the patient throughout the protocol (one-­‐to-­‐one).