Fatality after an Injection of Bicillin into the Tonsillar Fossa During an Adenotonsillectomy

Gerber, Nicholas; Apseloff, Glen

doi:10.1067/mhn.2002.123043

Cited by 1 publication

(2 citation statements)

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“…According to a systematic review by Galvao et al ( 2013 ), four cases of death in the general population on account of BPG administration have been reported between 1954 and 2012. Another report by Steigmann and Suker ( 1962 ) described three more cases, unaccounted for in the review by Galvao et al In addition, the medication is currently marketed with a black-box warning regarding intravenous administration, based on several reports of inadvertent IV administration of BPG that resulted in cardiorespiratory arrest and death (Steigmann and Suker, 1962 ; Levetan et al, 1988 ; Gerber and Apseloff, 2002 ). The most likely pathophysiologic explanation for these fatalities is that the BPG compound is a crystalline powder that may cause direct damage when injected into a blood vessel, possibly eliciting vascular spasm and subsequent occlusion by the large crystals of the penicillin salt (Gerber and Apseloff, 2002 ).…”

Section: Introductionmentioning

confidence: 99%

“…Another report by Steigmann and Suker ( 1962 ) described three more cases, unaccounted for in the review by Galvao et al In addition, the medication is currently marketed with a black-box warning regarding intravenous administration, based on several reports of inadvertent IV administration of BPG that resulted in cardiorespiratory arrest and death (Steigmann and Suker, 1962 ; Levetan et al, 1988 ; Gerber and Apseloff, 2002 ). The most likely pathophysiologic explanation for these fatalities is that the BPG compound is a crystalline powder that may cause direct damage when injected into a blood vessel, possibly eliciting vascular spasm and subsequent occlusion by the large crystals of the penicillin salt (Gerber and Apseloff, 2002 ). BPG also carries a warning regarding impairment of renal function—since BPG is excreted mainly by the kidneys, patients with suboptimal renal function may have a relatively higher risk for crystal formation and subsequent tubular damage ( 1991 ).…”

Section: Introductionmentioning

confidence: 99%

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Fatal and Near-Fatal Non-allergic Reactions in Patients with Underlying Cardiac Disease Receiving Benzathine Penicillin G in Israel and Switzerland

et al. 2017

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Benzathine Penicillin G (BPG) is commonly used for treatment of penicillin-susceptible infections and secondary prevention of rheumatic fever. Death following administration of BPG is extremely rare—only a handful of cases have been described in the literature since the 1950's. In this case series from Israel and Switzerland, we describe nine cases of serious adverse reactions—six fatal reactions and three near-fatalities—occurring within minutes of receiving intramuscular BPG. Allergic reactions or faulty administration were not implicated in any of the cases; however, all patients had cardiac risk factors. This case series describes a relatively rare risk that should be borne in mind when prescribing BPG.

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