Health Update: Penicillin G Benzathine (Bicillin L-A) Shortage Continues

Disease Prevention and Control

Situational Update:

On January 21, 2026, the manufacturer of penicillin G benzathine (Bicillin L-A), announced that the national shortage continues, thus extending the expected Bicillin L-A shortage into the 4th Quarter of 2026, with periodic release of limited quantities to distributors until then.

The next anticipated release of Bicillin L-A 1.2 MU and 2.4 MU prefilled syringes is July 2026, and December 2026 for pediatric 600,000 units prefilled syringes.

Bicillin L-A is the only acceptable treatment 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. Using Pfizer’s Medical Request Process, providers and pharmacy directors who no longer have access to Bicillin L-A through their health system or distributor can submit a medical request form for patients with confirmed congenital syphilis or those at risk of congenital syphilis.

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.

Extencilline and Lentocilin were approved by the FDA for temporary importation due to prior shortages and both are safe for use in pregnant patients. Effective Monday, March 9, Lentocilin can be ordered through a CostPlus marketplace account. CDC has developed a Lentocilin preparation and administration guide for clinicians. As of January 5, 2026, Extencilline is no longer available for distribution.

Limited data support ceftriaxone as an effective therapy option for the treatment of primary and secondary syphilis, and neurosyphilis, in non-pregnant adults. Refer to the California Department of Public Health and CDC Bicillin L-A health updates for additional information, including data for other alternative treatment options for syphilis. Other intramuscular formulations of penicillin (e.g. Bicillin C-R) are not acceptable alternatives for the treatment of 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. 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.
  4. Contact SF City Clinic at (628) 217-6677 if you are having trouble obtaining Bicillin L-A and update SFDPH on your Bicillin L-A inventory.

Additional Resources:

Program Contact Information

San Francisco City Clinic
Tel: (628) 217-6674
Email: stephanie.cohen@sfdph.org

To view or sign up for SFDPH Health Alerts, Advisories, and Updates visit: https://www.sf.gov/resource--2024--health-alerts