During Penicillin Shortage, Prioritize Treatment of Pregnant Women

Due to manufacturing delays, Pfizer is shipping only 30% of its normal monthly supply of penicillin G benzathine injectable suspension (Bicillin L-A) until July 2016.

The manufacturer recommends the use of alternative drugs when clinically appropriate, and patients for whom penicillin is the only treatment choice, such as pregnant women, should be prioritized.

The CDC recommends similar protocols until normal quantities of penicillin are available. For the treatment of primary, secondary, and early latent syphilis, the CDC advises adhering to the recommended dosing regimen of 2.4 million units of penicillin G benzathine IM.

The CDC also advised that additional doses of the treatment, including early doses for patients with HIV, doesn’t increase efficacy. In addition, the CDC stated that health care providers shouldn’t prescribe penicillin G benzathine for diseases like streptococcal pharyngitis if other antimicrobials are available.

Pharmacists may be receiving calls from prescribers to see if this product is available. Health care professionals should contact the Pfizer Supply Continuity Team (844-804-4677) about emergency supplies, and state and local sexually transmitted disease prevention programs should be notified of drug shortages.

This drug shortage is especially critical for pregnant women with syphilis because the untreated disease can cause miscarriage, stillbirth, and various complications including deformed bones, seizures, and blindness in the infant.

“The real tragedy is that it is a treatable infection,” Sarah Kidd, MD, MPh, a medical epidemiologist with the CDC’s Division of STD Prevention, told NPR, while highlighting the fact that there were 20,000 cases of syphilis transmission in 2014. “It is becoming a more common infection, and because this is the preferred regimen for treatment for syphilis, it really is a critical problem for syphilis control.”

NPR reported that the incidence of babies born with syphilis spiked after 2012. In 2014, there were around 500 infants born with syphilis.

“If [patients] have to go to a different clinic or place to get their Bicillin shot, it just increases the odds of transmission further before they’re cured, so it’s another potential barrier in the prevention and control of syphilis,” Dr. Kidd told NPR.

Pfizer is the only supplier of penicillin, which is part of the reason the supply chain is “fragile,” Erin Fox, director of the Drug Information Service at University of Utah Health Care, which tracks drugs across the country, told NPR.

Maryann Amirshahi, PharmD, MD, MPH, BCPS, DABAM, attending physician in the Department of Emergency Medicine at MedStar Washington Hospital Center and assistant professor of emergency medicine at Georgetown University School of Medicine, previously told Pharmacy Times that pharmacists play an important role in drug shortages.

“[Pharmacists] can often prevent shortages from impacting their institution by proactively managing inventory,” Dr. Amirshahi said. “When a shortage situation impacts hospital inventory, pharmacists should inform providers early.”