Bicillin® L-A Shortage and Syphilis Treatment

BICILLIN® L-A SHORTAGE AND SYPHILIS TREATMENT – CURRENT SITUATION

The State of Nevada Sexually Transmitted Disease (STD) Prevention and Control Program has been notified of a shortage of Bicillin L-A® (penicillin G benzathine) in the United States expected to last through the end of 2023. Penicillin G benzathine is the recommended treatment for syphilis, and the only recommended treatment for pregnant women infected or exposed to syphilis. The Centers for Disease Control and Prevention’s (CDC) Division of STD Prevention (DSTDP) is working with the Food and Drug Administration’s (FDA) Drug Shortage Staff, and Pfizer, to address this situation.

Recommendations for non-pregnant adults:

• Doxycycline 100 mg PO BID x 14 days is an acceptable alternative for those with primary, secondary or early latent syphilis.
• Doxycycline 100 mg PO BID x 28 days is an acceptable alternative for those with late latent syphilis or syphilis of unknown duration.

Use of other intramuscular formulations of penicillin, including Bicillin® C-R, are not acceptable alternatives for the treatment of syphilis.

Given the current Bicillin® L-A drug shortage, the Nevada Division of Public and Behavioral Health (DPBH) recommends the following:

1. Prioritize Bicillin® L-A for pregnant people with syphilis infection (or exposure) as well as for infant exposure to syphilis in utero.
2. Prioritize Bicillin® L-A for patients with contraindications to doxycycline (e.g., anaphylaxis, hemolytic anemia, Stevens Johnson syndrome).
3. Conserve Bicillin® L-A by using alternative drugs for the treatment of infectious diseases (e.g., streptococcal pharyngitis) where oral medications or other effective antimicrobials are available.
4. Contact your local health department if you are experiencing a Bicillin® L-A shortage and/or having trouble obtaining the medication.

Health Department	County	Phone Number to Report
Southern Nevada Health District (SNHD)	Clark	(702) 759-1300 (24 hours)
Washoe County Health District (WCHD)	Washoe	(775) 328-2447 (24 hours)
Carson City Health and Human Services (CCHHS)	Carson City, Douglas, and Lyon	(775) 887-2190 (24 hours)
Nevada Division of Public and Behavioral Health (DPBH)	All other counties	(775) 684-5911 (M-F 8am-5pm) (775) 400-0333 (after hours)

Follow-up clinical and serologic evaluation should be performed after treatment at the recommended intervals per the 2021 CDC Sexually Transmitted Infections (STI) Treatment Guidelines.

If you have questions about syphilis clinical management, please contact an infectious disease specialist, or the on-line National Network of STD Clinical Prevention Training Centers (NNPTC) STD Clinical Consultation Network at this network address: https://www.stdccn.org. The CDC is not recommending any changes to treatment recommendations for patients with syphilis.

For more information:

2021 STI Treatment Guidelines: https://www.cdc.gov/std/treatment-guidelines/default.htm

Food and Drug Administration Drug Shortage Website: https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Penicillin%20 G%20Benzathine%20Injectable%20Suspension&st=c

Centers for Disease Control and Prevention: https://www.cdc.gov/std/treatment/drug-notices.htm

Questions

For updated guidance, review the Nevada Office of State Epidemiology news web page regularly. Call (775) 447-4494 or e-mail ekessler@health.nv.gov or stateepi@health.nv.gov for other questions about the Bicillin® L-A Shortage and syphilis treatment.