Intravenous penicillin desensitisation protocol for adults
Ensure that penicillin desensitisation is appropriate for the patient (see Patient appropriateness for antimicrobial desensitisation) before performing intravenous penicillin desensitisation. Key requirements for antimicrobial desensitisation programs are listed in Key requirements for antimicrobial desensitisation programs.
A rapid intravenous benzylpenicillin desensitisation protocol is shown in Rapid intravenous benzylpenicillin desensitisation protocol for adults.
When benzylpenicillin treatment is required, desensitisation can be performed with either phenoxymethylpenicillin or benzylpenicillin. Intravenous desensitisation is more likely to cause anaphylaxis than oral desensitisation, so oral penicillin desensitisation is preferred.
When treatment with a penicillin other than benzylpenicillin (eg flucloxacillin) is required, desensitisation should be performed using a protocol specific to that drug – seek expert advice.
|
Step (at 15-minute intervals) |
Benzylpenicillin solution [NB1] |
Volume |
Dose |
Cumulative dose |
|
1 |
0.1 mg/mL |
0.1 mL |
0.01 mg |
0.01 mg |
|
2 |
0.1 mg/mL |
0.2 mL |
0.02 mg |
0.03 mg |
|
3 |
0.1 mg/mL |
0.4 mL |
0.04 mg |
0.07 mg |
|
4 |
0.1 mg/mL |
0.8 mL |
0.08 mg |
0.15 mg |
|
5 |
1 mg/mL |
0.16 mL |
0.16 mg |
0.31 mg |
|
6 |
1 mg/mL |
0.32 mL |
0.32 mg |
0.63 mg |
|
7 |
1 mg/mL |
0.64 mL |
0.64 mg |
1.27 mg |
|
8 |
10 mg/mL |
0.12 mL |
1.2 mg |
2.47 mg |
|
9 |
10 mg/mL |
0.24 mL |
2.4 mg |
4.87 mg |
|
10 |
10 mg/mL |
0.48 mL |
4.8 mg |
10 mg |
|
11 |
100 mg/mL |
0.1 mL |
10 mg |
20 mg |
|
12 |
100 mg/mL |
0.2 mL |
20 mg |
40 mg |
|
13 |
100 mg/mL |
0.4 mL |
40 mg |
80 mg |
|
14 |
100 mg/mL |
0.8 mL |
80 mg |
160 mg |
|
15 |
100 mg/mL |
1.6 mL |
160 mg |
320 mg |
|
16 |
100 mg/mL |
3.2 mL |
320 mg |
640 mg |
|
17 |
100 mg/mL |
6.4 mL |
640 mg |
1280 mg |
|
18 |
Observe for 30 minutes; if no reaction occurs, administer benzylpenicillin 1.2 g intravenously. After completing desensitisation, consider the desensitisation protocol as the first dose and start therapy at the standard dose and frequency required for the indication. | |||
|
Note:
NB1: Dilute reconstituted solution in sodium chloride 0.9%. | ||||