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Medical Advisory: Benzanthine Penicillin G (Bicillin® L-A) Shortage
Issued by: Dr. Azim Kasmani, MD, MSc, FRCPC, Medical Officer of Health and Commissioner
Date: January 26, 2026
The Ministry of Health has notified local public health units of an ongoing national shortage of Benzathine Penicillin G (Bicillin® L-A), the recommended first-line treatment for syphilis. We will continue to monitor the shortage and communicate updates accordingly.
Health care providers should restrict use of Bicillin® L-A and use alternative treatments for syphilis as per the Public Health Agency of Canada’s (PHAC) Interim Syphilis Treatment Guidelines in the Event of a Benzathine Penicillin G (Bicillin® L-A) Shortage
Use of Bicillin® L-A
The Ministry recommends that public health units and health care providers restrict the use of Bicillin® L-A to:
- Pregnant individuals (all stages) and their ongoing sexual contact(s). Note that infectious syphilis (primary, secondary, and early latent) only requires one dose of 2.4 million units of Bicillin® L-A, including during pregnancy.
- Infectious cases (primary, secondary and early latent syphilis), regardless of HIV status, if adherence to alternative treatment and follow-up is uncertain
Alternative Treatment
During the Bicillin® L-A shortage only, the Ministry recommends oral doxycycline as the preferred treatment for initiating therapy in:
- Non-pregnant adult patients with late latent
- Latent of unknown duration
- Tertiary syphilis that does not involve the central nervous system
If there is no uncertainty regarding staging of late latent syphilis, clinicians may opt to defer initiation of treatment until the supply is restored. Clients who have already initiated their treatment course with Bicillin® L-A should complete their therapy with Bicillin® L-A according to standard guidelines.
More Information
Public Health nurses are available to support with the management of positive syphilis test results, including consultation on appropriate treatment options. Please call 905-688-8248 ext. 7723 to speak with a nurse.
