Table 2.

Standard Best Practices for BPG Administration Including Recommendations to Reduce the Risk of Vasovagal Reactions

Standard best practice for BPG administration

BPG should be given by people trained in intramuscular injection and in recognition and treatment of anaphylaxis and vasovagal reactions Pain reduction and reassurance techniques should be used. and patients and guardians should be counseled about the signs/symptoms of vasovagal reactions Volume of diluent should be the minimum recommended by the manufacturer If possible, an anaphylaxis kit (minimum epinephrine) should be available (preferably in the room) wherever BPG is given If a patient or clinician recognizes signs/symptoms of presyncope, the patient should lie back down, and, if at low risk, attempt counterpressure maneuvers (eg, leg crossing, hand grip) Patients should be monitored for at least 30 min after injection for any signs of anaphylaxis or vasovagal syncope Countries/programs should have in place a mechanism for BPG adverse events reporting

Best practice to reduce the risk of vasovagal reactions triggered by BPG injection*
Minimize pain of injection (see #2 above) Have the patient drink 500 mL of water 30–60 min before injection † Have the patient eat a snack 30–60 min before injection Administer BPG in supine position ‡ Have the patient remain supine for at least 5 min after injection and rise slowly

BPG indicates benzathine penicillin G.

^*Inability to institute all of these recommendations in an individual setting should not preclude BPG administration.

^† If administering BPG to a patient with compromised ventricular function, hydration recommendations need to be customized by a health care professional.

^‡ Some patients and health care professionals may prefer a standing position for BPG administration, and these preferences should be handled on an individual basis.