Continued Bicillin® L-A Shortage, Lentocilin, and Syphilis Treatment

SUMMARY

Benzathine Penicillin G (BPG) is the only recommended treatment for syphilis during pregnancy. Bicillin® L-A, is the FDA-approved formulation of BPG in the U.S. The Nevada Division of Public and Behavioral Health (DPBH) issued a Technical Bulletin regarding a shortage of Bicillin in 2024; this shortage has continued and is projected to last through the end of 2027. CDC continues to recommend that jurisdictions preserve Bicillin for treating patients who are pregnant. FDA is allowing the temporary importation of Lentocilin©, due to the ongoing limited availability of Bicillin.

BICILLIN & LENTOCILIN

The most recent Pfizer Injectables Product Availability Report extended the next delivery of Bicillin™ L-A

1.2 million Units/2 mL and 2.4 million Units/4 mL (600,000 units/mL) prefilled syringes to October of 2026, with an estimated recovery date in the fourth quarter of 2027.

The FDA has approved Lentocilin to be imported due to the ongoing projected shortage of Bicillin. Lentocilin is benzathine benzylpenicillin tetrahydrate (penicillin G benzathine) powder reconstituted with a lidocaine diluent for suspension for injection. Details regarding preparation can be found in the linked documents below. Lentocilin contains soy phospholipids which may cause reactions in those with a history of soybean allergy. Lentocilin also contains lidocaine and should be used with caution in patients with cardiovascular, hepatic or renal disease. Lentocilin does not need to be refrigerated and can be stored below 77°F but must be used immediately following reconstitution.

Review the Lentocilin Information for Clinicians document and the Lentocilin Prescribing Information for additional details. To place an order contact TopRx at support@toprx.com or 1-800-542-8677.

RECOMMENDATIONS FOR HEALTH CARE PROVIDERS

• It is strongly recommended to preserve Bicillin and Lentocilin for treating patients who are pregnant since penicillin is the only recommended treatment for pregnant persons with syphilis and babies with congenital syphilis.
• Oral doxycycline is an acceptable form of treatment of syphilis among people who are not pregnant and do not have medical contraindications to doxycycline.
• Accurately stage syphilis cases to ensure appropriate use of antimicrobials. Syphilis staging resources are available through the National STD Curriculum and the New York City Department of

Health and Mental Hygiene Bureau of Sexually Transmitted Infections and the New York City STD Prevention Training Center.

For primary, secondary, or early latent syphilis, alternative treatment options for non-pregnant people include:

• Doxycycline: 100mg orally twice a day for 14 days
• Tetracycline: 500 mg orally 4 times/day for 14 days

For late latent syphilis or syphilis of unknown duration, alternative treatment options for non-pregnant people include:

• Doxycycline: 100mg orally twice a day for 28 days
• Tetracycline: 500 mg orally 4 times/day for 28 days

• Refer to the CDC’s STI Treatment Guidelines and if you need clinical decision-making support, contact the STD Clinical Consultation Network.
• Customers are encouraged to refer to the Pfizer Injectables Product Availability Report, or the online search tool here. Alternatively, contact your organization’s Pfizer Hospital & Biosimilars sales representative or health system director for the most current information.
• Take inventory of current supply levels and determine approximate needs. Continue to contact distributors to obtain Bicillin and Lentocilin as appropriate. If a distributor has no more supply, and Bicillin is needed for individual pregnant patients or neonates with syphilis, utilize the Pfizer Bicillin-LA request form to request product.
• Consult with antimicrobial stewardship personnel to limit the unnecessary use of Bicillin and encourage alternative effective treatment options for other infections.
• Bicillin is one of the preferred prophylactic regimens for patients with acute rheumatic fever or rheumatic heart disease to reduce the likelihood of recurrent Streptococcal infections and acute rheumatic fever episodes. Twice daily administration of oral penicillin V is an alternative option for prophylaxis, Clinical Guidance for Acute Rheumatic Fever | Group A Strep | CDC.

If your healthcare facility is experiencing Bicillin supply issues and are unable to obtain Lentocilin, notify your respective Local Health Authority.

Local Health Authority	Jurisdiction	Phone Number to Report
Southern Nevada Health District (SNHD)	Clark	(702) 759-1300 (24 hours)
Northern Nevada Public Health (NNPH)	Washoe	(775) 328-2447 (24 hours)
Carson City Health and Human Services (CCHHS)	Carson City, Douglas, and Lyon	(775) 887-2190
Central Nevada Health District (CNHD)	Churchill, Mineral, Eureka, and Pershing	(775) 866-7535 (24 hours)
Office of State Epidemiology (OSE)	All other counties	(775) 400-0333 (24 hours)

RECOMMENDATIONS FOR LOCAL HEALTH AUTHORITIES

Notify the Office of State Epidemiology of any Bicillin shortages reported in your jurisdiction.

QUESTIONS

For updated guidance, review the Division of Public and Behavioral Health Technical Bulletin webpage regularly. Email DPBHEpi@health.nv.gov for other questions regarding Continued Bicillin Shortage, Lentocilin, and Syphilis Treatment.