3. Probenecid should not be used with IV penicillin G. Probenecid is often used with oral penicillin preparations and with IM procaine or benzathine penicillin G to enhance serum levels by decreasing renal excretion. With IV penicillin, serum levels are easily adjusted by changing the dose, and probenecid is both unnecessary and dangerous. Probenecid predisposes patients to penicillin neurotoxicity by raising the CSF level and the serum level. This is the case because probenecid inhibits the active transport system that removes penicillin G from CSF after the drug has entered by passive diffusion. 4. Although it is possible to predict that some patients are more likely than others to have penicillin-susceptible strains, all patients with life-threatening disease should receive high-dose therapy until such susceptibility has […]
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