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:
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Reconstitute 5 million unit vial to 250,000 units/mL
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Draw out 0.2 mL
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Inject into 250 mL bag NS
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Label as Solution 1 Solution 2:
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Reuse 5 million unit vial from Solution 1
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Draw out 1.6 mL
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Inject into 250 mL bag NS
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Label as Solution 2 Solution 3:
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Reconstitute 5 million unit vial to 1 million units/mL
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Draw out 4 mL
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Inject into 250 mL bag NS
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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 the conclusion of protocol, observe patients for 30 minutes. The next dose can be a full therapeutic dose given by the desired route.
Desensitization protocol instructions: Prime tubing with contents of Solution 1
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Confirm written consent is in the medical record.
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Ensure the preceding dose of beta-‐blocker was held, unless otherwise advised.
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Obtain IV access, and vital signs (temp, HR, BP, RR, oxygen saturation, peak flow).
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Have at the bedside: Epi-pen, oxygen, normal saline, peak flow meter, and BP cuff, albuterol, IV diphenhydramine, and methylprednisolone.
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A nurse must closely observe the patient throughout the protocol.
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Last Update: 11/15/19