Bicillin Shortage

There is an ongoing shortage of penicillin G benzathine (Bicillin L-A) estimated to last until at least the fourth quarter of 2024. This limited supply poses significant challenges to addressing various infectious diseases, especially congenital syphilis. Bicillin L-A is the only recommended treatment option for syphilis for women infected or exposed during pregnancy. Thus, healthcare providers should prioritize Bicillin L-A to protect babies exposed to syphilis in utero.

Recommendations for Healthcare Providers

1. Conservation of Bicillin L-A: Given the shortage, DSHS advises healthcare providers to optimize the use of Bicillin L-A by reserving it for pregnant women with syphilis infection or exposure and for infants exposed to syphilis in utero. Determine a syphilis case’s stage before treatment to ensure appropriate conservation of antimicrobials. For example, early syphilis (primary, secondary, and early latent) only requires 2.4 million units of Bicillin L-A. Follow alternative regimens for other conditions to the extent possible during the shortage. Consider involving antimicrobial stewardship leaders to help institute systems-level treatment approaches.

2. Communication with Patients: Proactively communicate with patients about the shortage and provide clear guidance on the available treatment options. Explain any modifications or adjustments to their treatment plan to ensure patient understanding and compliance. Providers should perform follow-up clinical and serologic evaluations after treatment at the recommended intervals per the CDC STI Treatment Guidelines.

3. Collaboration within Healthcare Networks: Collaborate and share information on the availability of Bicillin L-A, alternative treatment options, and best practices with other healthcare providers and organizations in your network. This collaboration will enhance the understanding and management of the shortage situation.

4. Stay Updated: Stay informed about any updates or changes to the Bicillin L-A shortage through reliable sources such as the DSHS website, the Food and Drug Administration (FDA), the CDC, local health departments, and professional healthcare associations. Regularly check for new information and promptly disseminate updates to your healthcare team.

5. Notify Public Health: Notify DSHS at hivstd@dshs.texas.gov of any shortage of this product, and report the negative effects of the Bicillin L-A shortage or alternative treatments. This information will help public health monitor the ongoing effect of the shortage, develop appropriate response strategies, and provide situational awareness to the CDC and FDA.

Additional Resources

• CDC Announcements About the Bicillin L-A Shortage
• FDA Announcements About the Bicillin L-A Shortage
• Clinical Reminders During the Bicillin L-A Shortage (CDC)
• FDA Drug Shortages

DSHS staff are closely monitoring the Bicillin L-A shortage situation and remain committed to working diligently to mitigate its effects. For questions or concerns regarding the Bicillin L-A shortage, contact the DSHS at hivstd@dshs.texas.gov.