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Health advisory: Benzathine penicillin G shortage

The U.S. Food and Drug Administration (FDA) has announced a shortage of long-acting penicillin G benzathine injectable suspension products (Bicillin L-A), with an estimated recovery not before spring of 2024. Per the FDA, this drug shortage is due to an increased demand for the drug. Given the high rates of syphilis in California and in Santa Clara County, this is of significant concern.

Bicillin L-A remains the only acceptable treatment for pregnant people infected with or exposed to syphilis and should be prioritized for this population to prevent the harmful effects of congenital syphilis, including premature birth, low birth weight, birth defects, stillbirth, and infant death.

Acceptable alternative treatments for non-pregnant adults include:

  1. Primary, Secondary, Early Latent syphilis or exposure to syphilis:

Doxycycline 100mg PO BID x 14 days

  1. Late Latent/ Unknown Duration syphilis: Doxycycline 100mg PO BID x 28 days

Bicillin C-R is not an acceptable alternative for the treatment of syphilis.

In accordance with a recent CDPH health advisory on this subject, we recommend the following steps for clinicians:

  1. Prioritize Bicillin L-A for pregnant people with syphilis exposure or infection.
  2. Prioritize Bicillin L-A for infants exposed to syphilis in utero.
  3. Prioritize Bicillin L-A for patients with a doxycycline allergy.
  4. For non-pregnant adults with syphilis exposure or infection, use doxycycline as the alternative treatment regimen unless contraindicated.
  5. Conserve Bicillin L-A by using alternative oral drugs for the treatment of other infections such as group A strep pharyngitis and primary rheumatic fever prophylaxis.
  6. Call the County of Santa Clara Public Health Department at 408-792-3720 if you are having difficulty obtaining Bicillin L-A for a patient who needs it or have other questions regarding syphilis treatment.



  1. FDA Drug Shortages: Penicillin G Benzathine Injectable Suspension. U.S. Food and Drug Administration (FDA). Accessed June 2023.
  2. 2021 CDC STI treatment guidelines. Centers for Disease Control and Prevention. 2021
  3. Congenital Syphilis. California Department of Public Health. Accessed June 2023.
  4. Health Advisory: Bicillin L-A (Benzathine Penicillin G) Shortage. California Department of Public Health. June 2023.
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