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Bicillin is used to treat congenital syphilis among other diseases.

Long-acting injectable penicillin in short supply

June 20, 2023

A long-acting injectable penicillin used for children and pregnant women is in short supply, and the shortage may continue until next year.

Pfizer recently sent a letter to customers about supply issues impacting Bicillin L-A (penicillin G benzathine injectable suspension) and Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) prefilled syringes.

“It’s another example of a shortage where there may be a subset of patients for whom there aren’t other options where pediatricians are going to have to help families look around and find the drugs they need when they can,” said Adam J. Ratner, M.D., M.P.H., FAAP, a member of the AAP Committee on Infectious Diseases and professor of pediatrics and microbiology at NYU Grossman School of Medicine.

Pfizer said its supply of Bicillin L-A pediatric 600,000 units/mL prefilled syringes is expected to be depleted this month. Bicillin C-R supplies are estimated to be depleted in early fall. Bicillin L-A for adults is listed as being in limited supply, but Pfizer is prioritizing its production. One use of this formulation is the treatment of pregnant women with syphilis, which helps protect their babies from the disease.

Bicillin also is used to treat babies who have congenital syphilis, which has been on the rise. The AAP Red Book has in-depth information on treatment options for syphilis.

Bicillin also has been used as an option for treating strep throat, especially during the shortage of amoxicillin that began last fall. Several companies still have limited availability of amoxicillin, according to the Food and Drug Administration (FDA).

In addition, Bicillin is used as prophylaxis for people with history of acute rheumatic fever.

“It’s not a case where you could easily switch to something else,” Dr. Ratner said. “It’s potentially a major problem for some patients.”

Pfizer does not expect Bicillin supplies to recover until next year. It advised customers to check its availability report for updates.

In addition to amoxicillin, pediatricians have been grappling with shortages of attention-deficit/hyperactivity disorder drug Adderall. The AAP has been in close contact with the FDA about the impact drug shortages are having on clinicians. Pediatricians should report shortages to

To prevent resistance, clinicians should be sure their patient needs antibiotics before prescribing them. Most infections in children are caused by viruses not bacteria.




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