Q&A: Penicillin shortage threatens congenital syphilis treatment
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Key takeaways:
- A penicillin shortage in the United States is expected to last until at least mid-2024.
- The shortage could cause a further spike in congenital syphilis cases.
Last month, Pfizer announced that it was facing a “limited supply and impending stock out” for two of its injectable penicillin products, in part because of a surge in syphilis infections.
“The supply interruption is the result of a complex combination of factors, including significant increases in demand, due to an increase in syphilis infection rates as well as competitive shortages,” the company wrote in a letter to its customers.
Pfizer said Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) is estimated to deplete in the third quarter of 2023 and that Bicillin L-A (penicillin G benzathine injectable suspension) would likely be depleted by the end of the second quarter this year.
Rates of congenital syphilis have been steadily increasing. We spoke with Kristina A. Bryant, MD, a hospital epidemiologist at Norton Children’s Hospital in Louisville, Kentucky, and professor of pediatric infectious diseases at the University of Louisville, about the shortage and how it will affect the treatment of congenital syphilis.
Healio: What is causing the penicillin shortage, and how long is it expected to last?
Bryant: Pfizer, the manufacturer of LA-Bicillin, has cited increased demand for long-acting penicillin G benzathine due to increases in syphilis infection rates and shortages of other drugs. For example, with shortages of amoxicillin earlier this year, some clinicians may have used LA-Bicillin to treat strep throat. The shortage is expected to last at least until the second quarter of 2024.
Healio: What impact is it having on treating infants for syphilis?
Bryant: In our community, supplies of LA-Bicillin are limited but not yet depleted. Right now, there is just a lot of worry. Penicillin G is the only recommended treatment for pregnant people with syphilis. If the shortage causes a delay in treatment or if treatment is not given, we could see increased cases of congenital syphilis.
Up to 40% of infants born to pregnant people with untreated syphilis will be stillborn, suffer early infant death or experience serious complications, including deafness, blindness and bone damage.
Healio: In the context of a drug shortage, are infants prioritized above adults in treatment?
Bryant: Right now, the emphasis is on preventing congenital syphilis and the sequelae of congenital syphilis. According to public health experts, LA-Bicillin should be reserved for pregnant individuals infected with or exposed to syphilis and for infants exposed to syphilis in utero.
Reference:
- Availability update for Bicillin L-A (penicillin G benzathine injectable suspension) and Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) prefilled syringes. https://www.fda.gov/media/169427/download. Published June 12, 2023. Accessed July 16, 2023.
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