Health Professionals Update – Vol. 19, No. 5
From:
Dr. Gayane Hovhannisyan, MD, MPH, PhD, FRCPC, AMOH
In this issue
- Ongoing national shortage of Benzathine Penicillin G (Bicillin LA)
- Guidance for syphilis treatment during shortage
- Preferred alternative treatments
- Medication ordering updates
Key messages
- There is a critical national shortage of Bicillin LA 1.2 million IU/2 mL in Ontario and Canada.
- Health care providers must restrict Bicillin LA use and follow PHAC Interim Syphilis Treatment Guidelines.
- Doxycycline remains available and is the preferred alternative for non-pregnant adults.
Ongoing national Benzathine Penicillin G (Bicillin LA) shortage
Canada continues to experience a critical shortage of Bicillin LA 1.2 million IU/2 mL.
Peel Public Health is advising health care providers to restrict the use of Bicillin L-A and use alternative treatments per Public Health Agency of Canada Interim Syphilis Treatment Guidelines.
Use of Bicillin LA for treatment of Syphilis during the shortage
Bicillin LA should be reserved for:
- Pregnant individuals and their ongoing sexual contacts.
- Infectious syphilis (primary, secondary, early latent): Bicillin LA 2.4 million units IM as a single dose.
- Late latent or latent of unknown duration: Bicillin LA 2.4 million units IM weekly x 3 doses.
- Infectious syphilis cases (primary, secondary, early latent), regardless of HIV status, if adherence or follow-up with alternatives is uncertain.
- Patients who have already initiated therapy with Bicillin LA should complete the standard dosing schedule with Bicillin LA.
Preferred alternative treatment
Oral doxycycline is recommended for non-pregnant adults and their contacts with:
- Infectious syphilis (primary, secondary, early latent): Doxycycline 100 mg PO BID x 14 days
- Late latent syphilis and Latent syphilis of unknown duration: Doxycycline 100 mg PO BID x 28 days
Patients diagnosed with, or suspected of having, neurosyphilis should be referred to an Infectious Disease Specialist for staging and appropriate treatment.
Ordering Doxycycline and Bicillin from Peel Public Health
Due to limited and uncertain resupply, Peel Public Health is suspending all bulk orders of Bicillin LA.
Bulk doxycycline and individual Bicillin orders remain available through Peel Region STI Medication Distribution Program. Health care providers in Peel region can order free medications to treat syphilis, as well as chlamydia and gonorrhea.
Complete the appropriate form and fax to the number indicated on the form:
- STI medication and condom order form (including doxycycline)
- Bicillin order form for community physicians - you will need to right click on the link to save the document and open it in Adobe Reader and not through the browser.
More information
Contact us
The Health Professionals Update (HPU) is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic.
More information:
For questions about this update, email healthprofessionals@peelregion.ca.