Benzathine Penicillin G (Bicillin ® L-A) Shortage and Temporary Syphilis Treatment Guidance

Key Messages

• Hamilton Public Health Services is notifying health care providers of a national shortage of Benzathine Penicillin G (Bicillin® L-A) 1,200,000 IU/2mL, indicated as the first line treatment for syphilis.
• During the shortage, health care providers should restrict use of Bicillin® L-A and use alternative treatments for syphilis as per the Public Health Agency of Canada’s (PHAC) Interim Syphilis Treatment Guidelines in the Event of a Benzathine Penicillin G (Bicillin® L-A) Shortage.

Recommendations

During the shortage, the use of Bicillin® L-A should be restricted to:

• Pregnant individuals and their ongoing sexual contact(s). Please note that infectious syphilis (primary, secondary, and early latent), including during pregnancy, only requires one dose of 2.4 million units of Bicillin® L-A.
• Infectious cases (primary, secondary, and early latent syphilis), if adherence to alternative treatment and follow-up is uncertain.
• Non-pregnant adults who have already initiated their treatment course with Bicillin® L-A should complete their therapy with Bicillin® L-A.

During the Bicillin® L-A shortage, oral doxycycline is the preferred treatment for initiating therapy in non-pregnant adult individuals with late latent syphilis, latent syphilis of unknown duration, or tertiary syphilis that does not involve the central nervous system.

If there is no uncertainty regarding staging of late latent syphilis, clinicians may opt to defer initiation of treatment until the supply of Bicillin® L-A is restored.

Additional Resources

Please refer to the federal guidance and supporting documents for further details.

• Interim Syphilis Treatment Guidelines in the event of a Benzathine Penicillin G (Bicillin L-A) Shortage - Canada.ca
• Health Product Shortages Canada

Healthcare providers can order STI medications by faxing the STI Medication Ordering Form, available at www.hamilton.ca/hcp-STI, to 905-546-2203

Contact

If you have any questions related to this medical advisory, call 905-528-5894 to speak with a Public Health Nurse Monday to Friday 8:30 am to 4:30 pm.

Closing

Hamilton Public Health Services will continue to monitor the shortage and communicate updates as needed including when the above clinical recommendations during this shortage no longer apply.