Health Update: Penicillin G Benzathine (Bicillin L-A) Expiration Dates Extended for Some Lot Numbers as Nationwide Shortage Continues

Disease Prevention and Control

Situational Update

The ongoing national shortage of penicillin G benzathine (Bicillin L-A) is still projected to extend through October of 2027, with periodic release of limited quantities until then.

In response, the U.S. Food and Drug Administration (FDA) assessed whether current Bicillin L-A stock with short expiration dates could be extended. On September 21, 2026, the FDA announced that extended use dates are supported for specific lot numbers. You can search for specific lot numbers of Bicillin L-A on the FDA website, with the new corresponding extended use date listed.

Additionally, the San Francisco Department of Public (SFDPH) recommends clinics and hospitals with limited stock of Bicillin L-A order Lentocilin (Benzathine Benzylpenicillin Tetrahydrate) which is an alternative to Bicillin L-A for patients for whom doxycycline is contraindicated.

Bicillin L-A and Lentocilin are the only acceptable treatments for syphilis during pregnancy and should be prioritized for pregnant people infected with or exposed to syphilis and for newborns and infants exposed to syphilis in utero.

Among non-pregnant adults, doxycycline 100 mg PO BID x 14 days is an acceptable alternative for patients with primary, secondary, or early latent syphilis, and for patients who have been exposed to someone with infectious syphilis. Doxycycline 100 mg PO BID x 28 days is an acceptable alternative for people with late latent syphilis.

Other intramuscular formulations of penicillin (e.g. Bicillin C-R) are not acceptable alternatives for the treatment of syphilis. Refer to the California Department of Public Health and CDC Bicillin L-A health updates for additional information on alternative treatment options for syphilis.

Actions Requested of SF Clinicians

  1. Prioritize penicillin G benzathine (Bicillin L-A) for pregnant people and infants with syphilis infection or exposure, and patients with an allergy to doxycycline.
  2. Use doxycycline to treat non-pregnant adults with primary, secondary, early latent or late latent syphilis, or who are contacts to someone with syphilis, and who are able to adhere to a multi-day regimen.
  3. Check your Bicillin L-A lot numbers to see if the expiration dates were extended and use them through the corresponding new use dates to help with supply.
  4. Retain all Bicillin L-A inventory, even if past their labeled expiration date and not part of an extended lot. Clearly label these as “DO NOT DISCARD” and store them separately from active patient care stock in case more lot number expiry dates are extended.
  5. Request Bicillin L-A directly from Pfizer to treat patients with confirmed congenital syphilis or patients who are at risk of congenital syphilis if you cannot procure Bicillin L-A due to the shortage. An authorized healthcare provider or pharmacy director must complete the Pfizer Medical Request Form.
  6. Consider ordering Lentocilin given the ongoing shortage of Bicillin L-A.
    1. Lentocilin can be ordered through a Cost Plus marketplace account.
    2. If you are unable to procure Lentocilin or Bicillin L-A, you can request Lentocilin from SFDPH.
    3. Refer to CDPH’s Lentocilin overview (includes how to purchase) and Lentocilin preparation and administration primer, and CDC’s Lentocilin preparation and administration guide for clinicians.
    4. Find additional Lentocilin resources on the SF City Clinic website.
  7. Contact SF City Clinic at (628) 217-6677 if you no longer have access to Bicillin L-A.
  8. Use alternative drugs to treat group A strep pharyngitis and for primary rheumatic fever prophylaxis, e.g. penicillin V, amoxicillin, and azithromycin to conserve Bicillin L-A.

Additional Resources

Program Contact Information

San Francisco City Clinic

Tel: (628) 217-6674

Email: stephanie.cohen@sfdph.org

View or sign up for SFDPH Health Alerts, Advisories, and Updates at sf.gov/healthalerts