Wisconsin DHS Health Alert #67: Shortages of Bicillin® L-A (Penicillin G Benzathine Injectable Suspension)
Bureau of Communicable Diseases
August 8, 2025
Key Points
- Some Wisconsin health care facilities are experiencing shortages of Bicillin® L-A (Penicillin G Benzathine Injectable Suspension) due to the voluntary recall issued by Pfizer on July 10, 2025.
- Providers should review their current supply of Bicillin® L-A and prioritize its use in treating patients who are pregnant and infants with congenital syphilis.
- Doxycycline is appropriate for treatment of non-pregnant patients with syphilis in the outpatient setting. Doxycycline cannot be used for neurosyphilis, ocular syphilis, or all stages of syphilis occurring in pregnant patients.
- Health care facilities should consider preferentially using doxycycline syphilis for routine treatment of uncomplicated syphilis if they determine their supply may not be sufficient for the remainder of the calendar year.
Background
On July 17, 2025, the State of Wisconsin Department of Health (DHS) released Wisconsin Health Alert #65: Bicillin® L-A (Penicillin G Benzathine Injectable Suspension) Recall. This health alert detailed the recall of Bicillin® L-A (Penicillin G Benzathine Injectable Suspension) from Pfizer Pharmaceuticals.
The Wisconsin Department of Health (DHS), Sexually Transmitted Infections (STI) Unit has been monitoring the impact of this recall on access to effective treatment for syphilis. We have determined that some health care facilities in Wisconsin are currently experiencing shortages of Bicillin® L-A, which may impact patient care.
Shortage of Penicillin G Benzathine Injectable Suspension
As of July 31, 2025, the U.S. Food and Drug Administration (FDA) has issued a medication shortage alert. Pfizer is still working to determine the impact of the recall on their production timeline.
At this time, some Wisconsin health care facilities are experieicng shortages of Bicillin® L-A, including several clinics who reported having no doses in stock. Organizations that use PCN for the treatment of syphilis should immediately determine if the medication they have on hand is a part of the recalled lots. The lot numbers as well as other information about the recall can be found in the letter from Pfizer.
Providers can request emergency shipment of PCN on a patient-by-patient basis by requesting shipment directly from Pfizer through the Bicillin L-A Medical Request Form. According to Pfizer, this process is meant to ensure that available inventory in Pfizer’s distribution centers are equally distributed to hospitals and clinics treating patients with the highest medical necessity. This is based on prior Centers for Disease Control and Prevention (CDC) guidance to prioritize product only for patients with confirmed congenital syphilis and risk of congenital syphilis.
PCN is the only treatment recommendation for patients who are pregnant. Doxycycline is recommended for treatment of non-pregnant patients who can tolerate it. Doxycycline cannot be used for neurosyphilis, ocular syphilis, or any stages of syphilis occurring in pregnant patients. A STI treatment recommendations reference sheet is available on the DHS STI Program web page.
DHS will continue to monitor shortages. If you are having trouble finding treatment for your patients, please reach out to the syphilis surveillance coordinator, Craig Berger, at craig.berger@dhs.wisconsin.gov or 608-266-1323.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist
Bureau of Communicable Diseases
Division of Public Health
Wisconsin Department of Health Services
Resources
Questions
Questions regarding this health alert or syphilis reporting and surveillance in Wisconsin may be directed to the Craig Berger, syphilis surveillance coordinator at 608-266-1323 or craig.berger@dhs.wisconsin.gov.
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