Clinicians ration penicillin amid syphilis surge

The spike in syphilis cases across the U.S. are spurring public health agencies to recommend that clinicians ration penicillin injectables, the preferred treatment, KFF Health News reported Feb. 1. 

In spring 2023, Bicillin L-A (penicillin G benzathine) fell into shortage because of increased demand for the drug exclusively manufactured by Pfizer. Amid the ongoing supply issue, the U.S. is temporarily importing the antibiotic Extencilline, and clinicians are prioritizing doses for pregnant patients. 

Bicillin L-A is the only safe syphilis treatment for pregnant patients. Congenital syphilis can cause miscarriage, stillbirth, prematurity and infant death shortly after birth, according to the CDC. Babies born with congenital syphilis are also susceptible to deformed bones, severe anemia, brain and nerve problems, and meningitis. An oral antibiotic, doxycycline, is also used to treat syphilis, but it too can cause bone and teeth deformities in newborns.

In 2022, about 3,700 syphilis cases were reported to the CDC — a tenfold increase from 2012, which noted 335 cases. Between 2018 and 2022, the number of cases in babies grew 183%. 

Each dose of injectable penicillin can cost hundreds of dollars each, requires cold storage and expires after 48 months, so clinicians must be strategic with their supply, KFF Health News reported. 

As of Jan. 16, the 1, 2 and 4 milliliter Bicillin L-A syringes are in shortage, while Pfizer has two Extencilline solutions available. The drugmaker told the American Society of Health-System Pharmacists it is allocating resources toward manufacturing adult Bicillin-LA, including decreasing its output of Bicillin C-R (penicillin G benzathine/penicillin G procaine). 

"Once current supplies of the pediatric Bicillin-LA vials are depleted it is unclear when more product will be manufactured," Pfizer told the ASHP.

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