PROCAINE BENZYLPENICILLIN (PPF)

Broad spectrum penicillin antibacterial with both immediate effect of benzylpenicillin and prolonged effect due to procaine benzylpenicillin (12–24 hours); commonly abbreviated as PPF (procaine penicillin fortified)

Dosage Forms

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Powder for injection

3 MU procaine benzylpenicillin and 1 MU benzylpenicillin

Uses

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  • Severe bacterial infections
  • Neurosyphilis
  • Congenital syphilis

Dose and Duration

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All uses

Adult: 1–1.5 MU IM once daily

Child: 50,000 IU/kg (50 mg/kg) IM once daily

Use Duration
Severe pneumonia 5–10 days
Diphtheria 7 days
Neurosyphilis 10–14 days
Congenital syphilis 10 days

Preparation

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  • Dissolve in water for injection

Contraindications

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  • Allergy to penicillin or procaine
  • Give with caution if patient has cephalosporin allergy (cross-sensitivity may occur)
  • Intravenous injection

Side Effects

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  • Pain at injection site
  • Allergic reactions
  • Stomach upset
  • Seizures
  • Restlessness
  • Jarisch-herxheimer reaction (see caution)

Interactions

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  • (increased risk of methotrexate toxicity)

Patient Instructions

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  • Report to health worker immediately in case any severe rash occurs while on treatment

Pregnancy

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  • Can be used

Breast-feeding

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  • Can be used

Storage

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  • Once reconstituted, use suspension immediately

⚠️ Caution

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  • For IM injection only. Never use for IV injection or infusion
  • Give with caution to children below 1 year old as seizures and allergy due to procaine may occur
  • Reduce dose in severe kidney disease
  • Jarisch-herxheimer reaction can be prevented with 3 doses of oral prednisolone 20 mg every 12 hours
  • For treatment of severe bacterial infections, PPF is third line to ampicillin and gentamicin
  • For acute ear infection or pneumonia, only use PPF if azithromycin is not available or child is not able to swallow oral medication