Health Update: Penicillin G Benzathine (Bicillin L-A) Shortage Continues Through 4th Quarter of 2027

Disease Prevention and Control

Situational Update

The ongoing national shortage of penicillin G benzathine (Bicillin L-A) is now projected to extend through the 4th Quarter of 2027, with periodic release of limited quantities to distributors until then. The next anticipated release of a limited supply of Bicillin L-A 1.2 MU and 2.4 MU prefilled syringes is October 2026. Pediatric 600,000 units prefilled syringes are not expected to be available until October 2027.

In response, the FDA is assessing whether current Bicillin L-A stock with short expiration dates may be extended. The San Francisco Department of Public Health (SFDPH) therefore requests that clinics, pharmacies, and health systems:

  1. Retain all Bicillin L-A inventory, including doses nearing or past their labeled expiration date. Clearly label these as “DO NOT DISCARD” and store them separately from active patient care stock.
  2. Continue to use in-date supply as appropriate.
  3. Expect updated guidance as soon as a formal determination is made in the next few weeks.

Penicillin G benzathine 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.

Lentocilin (Benzathine Benzylpenicillin Tetrahydrate) is an alternative to Bicillin L-A that can be used to treat patients with syphilis in whom doxycycline is contraindicated. The SFDPH recommends that clinics order Lentocilin given the ongoing shortage of Bicillin L-A.

  1. Lentocilin can be ordered through a Cost Plus marketplace account.
  2. CDC has developed a Lentocilin preparation and administration guide for clinicians.
  3. Extencilline is no longer available for distribution.

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. Retain all Bicillin L-A inventory, including doses nearing or past their labeled expiration date. Clearly label these as “DO NOT DISCARD” and store them separately from active patient care stock.
  4. Consider ordering Lentocilin given the ongoing shortage of Bicillin L-A.
  5. 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.
  6. Contact SF City Clinic at (628) 217-6677 if you no longer have access to Bicillin L-A and update SFDPH on your Bicillin L-A inventory here.

Additional Resources

Program Contact Information

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


To view or sign up for SFDPH Health Alerts, Advisories, and Updates visit: sf.gov/healthalerts