Benzylpenicillin administered intravenously is the drug of choice for bacterial meningitis if this disease is caused by sensitive strains of meningococci or pneumococci. Further important indications for an intravenous penicillin treatment are endocarditis caused by Streptococcus viridans, other hazardous streptococcal infections (severe pneumonia, arthiritis), neurosyphilis, actinomycosis, anthrax and clostridium infections.

Smaller doses are administered intramuscularly. A streptococcal pharyngitis can be treated with a single injection of a benzylpenicillin slow release preparation (if available). Erysipelas, fusospirochaetes angina (Vincent's angina), diphtheria, pneumococcal pneumonia and primary syphilis infections can also be treated intramuscularly. Secondary prophylaxis of rheumatic fever has become very rare.

Orally administered phenoxymethylpenicillin is a 'painless' alternative for streptococcal angina and other indications of the intramuscular therapy, as well as dog and cat bites. It can be considered in the early stages of Lyme disease if doxycycline is contraindicated.

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