Respiratory tract infections where compliance with oral treatment is unlikely
Alongside Pen V and Erythromycin, Bicillin C-R is used to treat strep throat, given as one IM injection
Cellulitis, erysipelas
Procaine penicillin is also used as an adjunct in the treatment of anthrax. Adverse effects
At high doses procaine penicillin can cause seizures and CNS abnormalities due to procaine present in it. Mechanism
It is a form of penicillin which is a combination of benzylpenicillin and the local anaesthetic agent procaine. Following deep intramuscular injection, it is slowly absorbed into the circulation and hydrolysed to benzylpenicillin — thus it is used where prolonged low concentrations of benzylpenicillin are required. Compendial status
British Pharmacopoeia

See also
Benzathine benzylpenicillin/procaine benzylpenicillin

References
External links
"Penicillin G Procaine". Drug Information Portal. U.S. National Library of Medicine.
Differential diagnosis
A renal colic must be differentiated from the following conditions:
biliary colic and cholecystitis
aortic and iliac aneurysms (in older patients with left-side pain, hypertension or atherosclerosis)
interstitial: appendicitis, diverticulitis or peritonitis (in this case patients prefer to lie still rather than being restless)
gynaecological: endometriosis, ovarian torsion and ectopic pregnancy
testicular torsion

Treatment
Most small stones are passed spontaneously and only pain management is required. Above 5 mm (0.20 in) the rate of spontaneous stone passage decreases. NSAIDs (non-steroidal anti-inflammatory drugs), such as diclofenac or ibuprofen, and antispasmodics like butylscopolamine are used. Although morphine may be administered to assist with emergency pain management, it is often not recommended as morphine is addictive and raises ureteral pressure, worsening the condition. Vomiting is also considered an important adverse effect of opioids, mainly with pethidine. Oral narcotic medications are also often used.There is typically no antalgic position for the patient (lying down on the non-aching side and applying a hot bottle or towel to the area affected may help). Larger stones may require surgical intervention for their removal, such as shockwave lithotripsy, laser lithotripsy, ureteroscopy or percutaneous nephrolithotomy. Patients can also be treated with alpha blockers in cases where the stone is located in the ureter. References


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