Patients with pneumococcal pneumonia were studied to determine if severely ill patients benefit more from massive dosages of penicillin compared with moderate dosages. Severity of illness and response to treatment were evaluated, and sputum was monitored for pathogens. Twenty-two of the 59 patients assigned to receive 20 million units of penicillin daily and 19 of the 64 assigned to receive 1,200,000 units of penicillin G procaine daily were considered severely ill. In the high-dosage group, there were five deaths, three patients with superinfections, and 22 with pathogen colonizations, and in the moderate-dosage group, six deaths, two patients with superinfections and eight with pathogen colonizations. There was no significant difference (P <.75) in outcome between the groups. We conclude that there is no advantage in treating patients with more than 1,200,000 units of penicillin G procaine daily.
(JAMA 230:409-413, 1974)