Bicillin shortage and temporary use of Lentocilin S for syphilis treatment

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To: Local Health Care Providers

Background

A national shortage of benzathine penicillin G (Bicillin® L‑A) continues to affect access to first‑line treatment for syphilis across Canada. In response to this shortage, Health Canada has authorized the exceptional, temporary importation and sale of Portuguese‑authorized Lentocilin S 1200 (1 200 000 IU / 4 mL) to support continuity of care. Given the ongoing shortage, access to Bicillin L-A and Lentocilin S will be prioritized for pregnant cases, sexual partners of pregnant cases, and infectious cases where adherence to treatment and follow-up is uncertain. When possible, all other cases should be treated with doxycycline.

Implications for clinical practice

Formulation and preparation:

• Lentocilin S contains the same active ingredient (benzathine benzylpenicillin), strength (1.2 million units), and intramuscular route of administration.
• Lentocilin S is supplied as a powder requiring reconstitution immediately prior to administration.
• The product must be reconstituted with the co‑packaged diluent containing lidocaine hydrochloride 1.5%, resulting in a final volume of 4 mL per 1.2 million units.
• For detailed information on product preparation, administration, contraindications, and safety monitoring, health care providers are encouraged to refer to Health Canada’s advisory on the temporary importation and use of Portuguese‑authorized Lentocilin S.

Allergy considerations

Lentocilin S contains soy phospholipids and may cause hypersensitivity reactions (urticaria, anaphylactic shock) in patients with a history of allergy to soybeans.

Medication order form

• We have updated the Medication Order Form to include Lentocilin S. The form can be found on our website.

Reporting to Public Health

• For information about syphilis treatment please refer to the Sexually transmitted infections and blood-borne infections guides for health professionals from the Government of Canada.
• For questions or support related to this shortage, please contact the Sexual Health Clinic at 705.522.9200, ext. 482 (toll-free 1.866.522.9200) or send an email to sexualhealthnoc@phsd.ca.
• Public Health will continue to monitor the national supply situation and provide further updates as they become available.

Sincerely,

Original Signed By

Emily Groot, MD, MPH, FRCPC (she/her)
Associate Medical Officer of Health