The Windsor-Essex County Health Unit (WECHU) is writing to inform you of the current national shortage of Benzathine Penicillin G (Bicillin® L-A), the first line of treatment for syphilis. The Public Health Agency of Canada (PHAC) recommends conserving available stock of Bicillin® L-A and using alternative treatments outlined in the Interim Syphilis Treatment Guidelines in the event of a Benzathine Penicillin G (Bicillin L-A) Shortage.
Effective immediately, it is recommended that health care providers restrict Bicillin® L-A to:
- Pregnant patients and their sexual contacts (within 90 days)
- Primary, secondary, and early latent infectious syphilis only require one dose of Benzathine Penicillin G 2.4 million units (m.u) IM, including during pregnancy.
- Infectious cases (primary, secondary and early latent syphilis), regardless of HIV status, if adherence to treatment and follow-up is uncertain
During the current Bicillin® L‑A shortage, oral doxycycline is recommended as the preferred alternative for non‑pregnant adults requiring treatment for late latent syphilis, latent syphilis of unknown duration, or tertiary syphilis without central nervous system involvement. In cases where the staging of late syphilis is uncertain, clinicians may consider deferring treatment until Bicillin® L-A supply is restored. Non‑pregnant adults who have already initiated therapy with Bicillin® L-A should continue and complete their treatment course in accordance with established clinical guidelines.
Should there be any changes to the current guidance, WECHU will communicate updates as they become available.