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Why is the world suffering from a penicillin shortage?

Just four companies produce the active ingredient for penicillin – a drug that changed modern medicine 76 years ago – and because the medicine offers little profit, those companies keep production levels low.

As penicillin has been used to treat diseases, such as syphilis and rheumatic heart disease, which disproportionately affect poorer countries, the extent of the demand for the drug also isn’t always clearly captured. In the case of syphilis, 5.6 million people are infected around the world every year, but that “is a small market from a pharmaceutical point of view,” explains Andy Gray, a consultant pharmacist and senior lecturer in pharmacology at the University of KwaZulu-Natal,…

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Though not approved in the US, Laboratoires Delbert’s extencilline will be the available alternative to Pfizer’s Bicillin L-A.

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A looming penicillin shortage threatens pregnant adults with syphilis and their newborns

Pfizer announced last week that it expects to run out of a key drug for treating syphilis in the near future — a looming problem that health professionals say could exacerbate syphilis rates, widen racial disparities in sexually transmitted diseases, and stymie global access to the antibiotic, especially within lower-income countries.

Antibiotic Shortage Could Worsen Syphilis Epidemic

The primary drug used to treat the sexually transmitted infection could be scarce into next year, Pfizer warns.

Benzathine penicillin – down but not out

Despite decades of penicillin use, all GAS isolates remain exquisitely sensitive to penicillin, with no resistance ever having been documented. This unique situation is why BPG works, despite the relatively low blood levels maintained over the weeks after the IM injection.

Bicillin CR vs LA

Select Bicillin® CR when treating strep pharyngitis. Select Bicillin® LA when treating syphilis… henceforth referred to as syphi-LA-s.

Clinical Reminders during Bicillin L-A® Shortage

Prioritize using Bicillin L-A® to treat pregnant people with syphilis and babies with congenital syphilis – penicillin is the only recommended treatment for these populations.

How Will My Rheumatic Fever Be Managed?

To stop the strep germ from getting into the body and to prevent rheumatic fever from happening again, you will need to have an injection of benzathine penicillin, also known as bicillin, every 21 to 28 days. You may hear healthcare professionals call this secondary prophylaxis.

Penicillin Shortage Could Be A Problem For People With Syphilis

Since it came onto the scene in 1943, penicillin has made syphilis a thing of the past — almost. Now, the sexually transmitted disease is making a comeback in the U.S. and there's a shortage of the medication used to treat it.

Pfizer warns of a looming penicillin supply shortage

The scarcity of penicillin comes amid a long-term shortage of prescription drugs the U.S. has been experiencing for the last decade, usually as a result of disruptions in the supply chain, like the one caused by the pandemic, Marta Wosińska, a visiting fellow at The Brookings Institution, told NPR earlier this year. Other prescriptions, such as Adderall and children's flu medication have also been in short supply.

Resources

StatPearls

Benzathine penicillin is formulated from two penicillin G molecules reacting with diphenylethylene diamine. It is active against gram-positive bacteria, including beta-hemolytic streptococci (groups A, B, C, G, H, L, and M) as well as Treponema pallidum and T. carateum.

WikEM

Rheumatic Fever Prophylaxis, Secondary - 1.2 million units IM every 4 weeks.