Skip to main content
CA.Gov State of California Logo
en Español Contact Us About News & Media Jobs/Careers
+ Increase Text Resize Reset to Default - Decrease
CDPH Site Logo
CDPH Site Logo
  • Text Size
      • + Increase Increase
      • - DecreaseDecrease
      • Reset to Default Reset to Default
  • I am looking for
      • What’s New

      • 2025 State of Public Health Testimony

      • CDPH New Look

      • H5N1 Bird Flu

      • Respiratory Virus Report

      • Tips for After an Earthquake

      • Wildfire Preparedness and Safety

      • CDPH 2025-26 Budget May Revision

      • Administrative

      • All Local Health Jurisdiction Letters & Notices

      • Budget Highlights

      • Boards and Advisory Committees

      • Forms

      • Language Access Services Program

      • Local Health Services/Offices

      • Public Records Act Request

      • Proposed Regulations

      • Proposition 56 Fiscal Reporting

      • Diseases and Conditions

      • Cancer

      • COVID-19

      • Diabetes

      • Diseases and Conditions

      • Disease Reporting

      • Healthcare-Associated Infections

      • HIV/AIDS

      • Mpox

      • Problem Gambling

      • Respiratory Viruses

      • Sexually Transmitted Diseases

      • See More
      • Family Health

      • Breastfeeding

      • Genetic Disease Screening

      • Mental Health

      • Nutrition and Physical Activity

      • Pregnancy and Reproductive Health

      • Women, Infants and Children

      • Health and Safety

      • Climate Change and Health

      • Emergency Preparedness

      • Environmental Health

      • Health in all Policies

      • Workplace Health

      • Health Facilities

      • File a Complaint

      • California Health Facilities Information Database

      • Personal Health and Prevention

      • Behavioral Health

      • Cannabis (Marijuana)

      • Immunizations

      • Nutrition

      • Quit Smoking

      • Licensing, Certification and Other Credentials

      • Certificates, Licenses, Permits and Registrations

      • Health Care Facility Licenses

      • Health Care Professionals

      • Laboratory

      • Medical Professional Licenses

      • Medical Waste

      • Pet Importation and Exportation

      • Radiation and Nuclear

      • Registered Environmental Health Specialist

      • Vital Records

      • X-ray Machine Registration

  • I am a
      • Clinician / Healthcare Provider

      • Legislator / Legislative Staff

      • Media Representative

      • Researcher / Statistician

      • Person Interested In

      • Infant and Child Health

      • Men’s Health

      • Senior Health

      • Women’s Health

      • Youth and Young Adult's Health

      • LGBT Health

  • Programs
      • Center for Healthy Communities

      • California Tobacco Control

      • Childhood Lead Poisoning Prevention

      • Chronic Disease Control

      • Chronic Disease Surveillance and Research

      • Emergency Preparedness

      • See More
      • Center for Preparedness and Response

      • Be Prepared California

      • Know and Understand Natural Disasters

      • Center for Family Health

      • Genetic Disease Screening Program

      • Maternal, Child and Adolescent Health

      • Women, Infants and Children

      • Center for Health Care Quality

      • Healthcare-Associated Infections Program

      • Licensing and Certification

      • Center for Health Statistics and Informatics

      • End of Life Option Act

      • Medical Marijuana Identification Card Program

      • Research and Analytics Branch

      • Vital Records

      • Center for Infectious Diseases

      • HIV/AIDS

      • Binational Border Health

      • Communicable Disease Control

      • Communicable Disease Emergency Response

      • Refugee Health

      • See More
      • Director / State Public Health Officer

      • Legislative and Governmental Affairs

      • Let's Talk Cannabis

      • Office of Health Equity

      • Office of Communications

      • See More
      • Center for Environmental Health

      • Division of Food and Drug Safety

      • Division of Radiation Safety and Environmental Management

      • See More
      • Center for Laboratory Sciences

      • Division of Environmental Health Laboratories

      • Infectious Diseases Laboratory Division

      • Laboratory Field Services

      • Office of State Public Health Laboratory Director

      • Operations Branch

      • See More
      • Other CDPH Offices

      • Privacy Office

      • Office of Regulations

      • See More
  • A-Z Index
Office of Communications

Skip Navigation LinksExtension-of-Long-Acting-Benzathine-Penicillin-G-Bicillin-L-A-Shortage Extension of Long-Acting Benzathine Penicillin G (Bicillin® L-A) Shortage
 

Top Menu
  • Office of CommunicationsCurrently selected
Skip Navigation LinksOffice of Communications > Pages > CAHAN > Extension-of-Long-Acting-Benzathine-Penicillin-G-Bicillin-L-A-Shortage
  • Home
  • Programs
  • Office of Communications
  • Extension of Long-Acting Benzathine Penicillin G (Bicillin® L-A) Shortage
Left Menu
  • Lists
  • Programs
    • California Conference of Local Health Officers
    • Center for Environmental Health
    • Center for Family Health
    • Center for Health Care Quality
    • Center for Health Statistics and Informatics
    • Center for Healthy Communities
    • Center for Infectious Diseases
    • Center for Laboratory Sciences
    • Director's Office
    • Emergency Preparedness Office
    • Human Resources Division
    • NBS
    • Office of CommunicationsCurrently selected
    • Office of Compliance
    • Office of Health Equity
    • Office of Legislative and Governmental Affairs
    • Office of Policy and Planning
    • Office of Problem Gambling
    • Office of Professional Development & Engagement
    • Office of the State Public Health Laboratory Director
  • Recent
CDPH Logo
TOMÁS J. ARAGÓN, M.D., Dr.P.H.
State Public Health Officer & Director
State of Cal Logo
GAVIN NEWSOM
Governor

State of California—Health and Human Services Agency
California Department of Public Health


Priority Health Communication Type

​​​​​​​

​​​                                          ​​ ​Health Advisory                                          ​​ ​​

TO: Healthcare Providers
Extension of Long-Acting Benzathine Penicillin G (Bicillin® L-A) Shortage
3/18/2024



Key Messages

​Key Messages 

  • The FDA and Pfizer announced extension of the long-acting benzathine penicillin G (Bicillin® L-A) shortage, with supplies now estimated to not recover until the 4th quarter of 2024. 

  • Healthcare providers and entities should continue to prioritize long-acting penicillin-based treatments (Bicillin® L-A and Extencilline®) for the treatment of pregnant people with syphilis and infants exposed to syphilis in utero. 

  • Oral doxycycline is an appropriate alternative treatment for non-pregnant adults with primary, secondary, early/late latent syphilis and syphilis of unknown duration. 


Summary

​Background 

The Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) previously announced the long-acting benzathine penicillin G (Bicillin® L-A) shortage and estimated recovery of supplies not before the 2nd quarter of 2024. Unfortunately, the time for expected recovery of supplies has now been extended to the 4th quarter of 2024. This change is reflected on both the FDA drug shortage webpage and Pfizer injectable product availability report (PDF)[1​​​][​2​].​ Bicillin® L-A and Extencilline® (PDF) are the only recommended treatments for all pregnant people with syphilis and certain infants exposed to syphilis in pregnancy. With continued concern about the number of pregnancies and infants affected by syphilis in California, it is of utmost importance that effective treatments be prioritized for these populations. 

Recommendations 

Given this extensio​n of the Bicillin® L-A shortage and continued uncertainty regarding the availability of long-acting penicillin-based syphilis treatments, CDPH recommends the following: 

  • Prioritize Bicillin® L-A over Extencilline® for infants exposed to syphilis in utero due to the larger volumes required of Extencilline® injections. If no Bicillin® L-A is available, then Extencilline® can be used in infants.  

  • Prioritize Bicillin® L-A and, if necessary, Extencilline® for pregnant people with syphilis infection (or exposure). 

  • Prioritize Bicillin® L-A and Extencilline® for patients with contraindications to doxycycline (e.g., anaphylaxis, hemolytic anemia, Stevens Johnson syndrome). 

  • Conserve Bicillin® L-A and Extencilline® by using alternative drugs for the treatment of primary, secondary, early/late latent syphilis and syphilis of unknown duration in non-pregnant adults as well as for other infectious diseases (e.g., streptococcal pharyngitis) where oral medications or other effective antimicrobials are available.  

  • CDPH has posted a Health Advisory with the acceptable alternative regimens for the treatment of primary, secondary, early/late latent syphilis and syphilis of unknown duration in non-pregnant adults​[​​3]. Alternative regimens for non-pregnant adults include: 

    • ​​​​​Doxycycline 100 mg PO BID for 14 days is an acceptable alternative for those with primary, secondary, or early latent syphilis. 

    • ​Doxycycline 100 mg PO BID for 28 days is an acceptable alternative for those with late latent syphilis or syphilis of unknown duration.  

Res​ources 

  • If needed, more information regarding the procurement and use of Extencilline® can be f​​​ound in the recent CDPH Dear Colleague Letter (PDF)[4]. Contact your local health department if you are experie​ncing difficulty obtaining Bicillin® L-A or Extencilline®.  

  • For clinical questions related to the treatment o​f syphilis during the Bicillin® L-A shortage, please contact the Sexually Transmitted Diseases (STD) Clinical Consultation Network, your local health department, or CDPH STD Control Branch at (510) 620-3400 by phone or stdcb@cdph.ca.gov by email. 

Referen​ces  

​​[1​] U.S. Food and Drug Administration: Drug Shortage Webpage 

[2] Pfizer: Injectable Product Availability Report (PDF) 

​[3] CDPH Health Advisory: Bicillin® L-A (Benzathine Penicillin G) Shortage  

[4​] CDPH Dear Colleague Letter: Powdered Benzathine Benzylpenicillin (Extencilline®) for the Treatment of Syphilis (PDF) 



Public Health Accredited Health Department Logo
California Department of Public Health
PO Box, 997377, MS 0500, Sacramento, CA 95899-7377
Department Website ( cdph.ca.gov )
PHAB
For General Public Information
  • (916) 558-1784
  • Contact Us
  • Web Accessibility Certification
  • Download pdf viewer
  • Feedback
  • Jobs/Careers
  • Privacy Policy
  • Sitemap
  • Use Policy
Useful Links
  • Visit Governor's Website
  • State Agency Directory
  • CA Health & Human Services
  • Centers for Disease Control and Prevention
Visit CDPH on Instagram for the latest updates and health tips. Follow CDPH on Facebook to stay informed and connected. Explore professional updates and news from CDPH on LinkedIn. Watch health-related videos and get updates from CDPH on YouTube. Stay up to date with tweets and announcements from CDPH on X. Get the latest information and stay informed with CDPH on Bluesky. Connect and engage with CDPH on Threads to get the latest updates.