[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
Purchase Options:
[Skip to Content Landing]
Other Articles
January 27, 1962

Fatal Reactions to Benzathine Penicillin G: Report of Three Cases and Discussion of Contributory Factors

JAMA. 1962;179(4):288-290. doi:10.1001/jama.1962.03050040042013

BENZATHINE PENICILLIN G has been used extensively in recent years, particularly in the treatment and prophylaxis of streptococcal infection and a venereal disease. The over-all reaction rate from this agent appears to be not significantly higher than from other salts of penicillin administered parenterally,as noted from the scarcity of reports of fatal reactions. Thus far, only 13 known fatalities have been recorded. If all the doses used in the United States were converted to 600,000 units, they would total more than 40 million, a roughly estimated fatality incidence of 1 per 3 million doses.

The purpose of this report is to describe fatal reactions in 3 patients shortly after they had received an injection of benzathine penicillin G as an antistreptococcal prophylaxis in the management of their rheumatic heart disease.

Report of Cases

Case 1.—A 19-year-old male was admitted because of congestive failure. His past history was essentially negative. He

Stollerman, G. H.:  Prevention of Rheumatic Fever ,  Med Clin N Amer 41:133-148 ( (Jan.) ) 1957.
Brooks, T. J., and Moe, T. I.:  Uses of Benzathine Penicillin G in Carriers of Group A Beta-Hemolytic Streptococci ,  JAMA 160:162-165 ( (Jan. 21) ) 1956.Crossref
Brown, W. J.; Simpson, W. G.; and Price, E. V.:  Benzathine Penicillin G in Oil: Clinical Evaluation in Treatment of Early Syphilis ,  Antibiot Ann , pp. 138-143, 1958-1959.
Sherwood, R. W.; Gronbeck, C.; and Denny, F. W., Jr.:  Reactions from Multiple Injections of Benzathine Penicillin G ,  JAMA 165:667-671 ( (Oct. 12) ) 1957.Crossref
Guthe, T.; Idsöe, O.; and Wilcox, R. R.:  Untoward Penicillin Reactions ,  Bull WHO 19:427-501 (No. (3) ) 1958.
Hsu, I., and Evans, J. M.:  Untoward Reactions to Benzathine Penicillin G in Study of Rheumatic-Fever Prophylaxis in Adults ,  New Engl J Med 259:581-583 ( (Sept. 18) ) 1958.Crossref
Goldman, S. L.:  Anaphylactic Death Following Repository Penicillin ,  Missouri Med 51:483-500 ( (June) ) 1954.
Roberts, E. F.:  Civilian Deaths Implicating Benzathine Penicillin G Injection , read at the  American Therapeutic Society, Miami, Fla., (June) 1960 .
Seal, J. R., et al.:  Penicillin Prophylaxis of Epidemic Streptococcal Infections: Effects of Small and Large Doses of Oral Penicillin on Epidemic Streptococcal Infections and on Carriers of Group A Streptococci ,  J Lab Clin Med 44:831-859 ( (Dec.) ) 1954.
Butterly, J. M., and Fishman, L.:  Jarisch-Herxheimer Reaction Following Penicillin Therapy in Case of Syphilitic Aortitis ,  JAMA 148:370-372 ( (Feb. 2) ) 1952.Crossref
Brown, E. A.:  Reactions to Organomercurial Compounds ,  Ann NY Acad Sci 65:545-552 ( (April 11) ) 1957.Crossref
Hamman, L.:  Sudden Death ,  Bull Johns Hopkins Hosp 55:387-415 ( (Dec.) ) 1934.
Scott, R. W., and Sancetta, S. M.:  Stokes-Adams Attacks Induced by Rectal Stimulation in Patient with Complete Heart Block ,  Circulation 2:886-889 ( (Dec.) ) 1950.Crossref
Johnson, E. G., et al.:  Streptococcal Infection in Adolescents and Adults after Prolonged Freedom from Rheumatic Fever: Results of First Three Years of Study ,  New Engl J Med 263:105-111 ( (July 21) ) 1960.Crossref