Bicillin Information
November 2011
EMAIL From Dr B...
I have a Bicillin story to share.
Many years ago, right after the Cimmino paper was published, in which Bicillin was used at 1.2 per week, I began trying it with mixed results. One day a patient and his wife, both of whom recently immigrated from Eastern Europe, came to me for advice. The wife had been a physician in the home country but did not yet get her USA credentials.
Anyway, the husband (patient) was so ill, he barely could hold a conversation, and was twitchy, swollen, and just mentally off. I prescribed Bicillin 1.2 per week, as per the article. The wife took over his care and they returned six months later for follow-up.
Amazingly, upon return, he was COMPLETELY NORMAL!
I was flabbergasted! I asked his wife what happened, and she said, "if once a week is good, then once a day would be better!"
She actually gave him 1.2 daily for the entire six months with a fabulous result.
As it turns out, 1.2 million units of Bicillin translates into only 1000 mg of penicillin. So even at 1.2 three times a week, that is actually less penicillin in a week than a patient gets in a day if he were prescribed oral amoxicillin!
I do not recommend daily Bicillin- I generally give adults the 1.2 three times a week- but if the person is large, or if they need IV-level results but cannot get IV for whatever reason, then Bicillin at more than 1.2 three times a week is certainly reasonable.
I like Bicillin for many reasons- Really no GI symptoms, minimal yeast concerns, it serves as a wonderful foundation for adding second and third drugs, and if administered carefully and correctly, then can be tolerated really long term. In selected patients, efficacy approaches that of IV Rocephin.
While I have reported on blood level testing with many oral meds and IV doxy, I have no data on penicillin blood levels after Bicillin, so I cannot advise on this. Perhaps if someone is doing this systematically he/she can report on it.
I hope this little vignette is helpful!
Dr. B..........................!
(Permission to share)