Factors Associated With Loss of Penicillin G Concentrations in Serum After Intramuscular Benzathine Penicillin G Injection: A Meta-analysis

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Background:An interval of 3–4 weeks between intramuscular injections of 1.2 million units of benzathine penicillin G as prophylaxis against group A streptococcal infection is recommended by health organizations for patients with pediatric rheumatic fever and heart disease.Methods:We reviewed the literature for evidence of the persistence of serum penicillin G during the first 4 weeks after the recommended dose of benzathine penicillin G.Results:The weighted-mean concentration was <0.02 µg/mL by 3 weeks after the initial dose. Weighted means were lower in studies done after 1990 than before (P < 0.01), in studies dealing with secondary versus primary prophylaxis (P < 0.01) and in studies in children versus those in adults (P < 0.02).Conclusions:Recommendations for benzathine penicillin G prophylaxis may need reevaluation.

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