Episode 196: Navigating the Syphilis Treatment Shortage

For providers and healthcare organizations dealing with limited supplies, what steps should they be taking right now to manage the shortage and prioritize use of benzathine penicillin?

Yeah.

So I think the, the most important thing is really monitoring your local supplies of, of benzathine p- uh, penicillin, um, a- a- and determining what the local pattern of use is and kinda to for- forecast your needs.

So many places have been doing this ongoing.

Uh, but again, continue to contract distri- the, the contact distributors to provide, uh, the, the BPG as, which is the, the benzathine penicillin G, as appropriate.

Um, you can also contact the company and, and request product for individual pregnant patients or neonates with syphilis.

Um, they have a medical request process, uh, if the distributor has no supply.

So let's say you have somebody in front of you, they're pregnant, and they're really gonna need to be treated, and you have no other options.

You could potentially call Pfizer, have somebody sign off on it.

You'd have to have somebody, uh, sign off that, uh, that, that you definitely need it for somebody who's pregnant, and, and they usually will be able to supply you something, um, for those situations.

Uh, we've done this successfully at Albany Med.

It was a li- little bit of a process, but I am sure other places have done the same.

But you really need, need it.

If they have limited supplies, they do have some to send out if you absolutely need it.

[clears throat] But most importantly, I think, um, this should only be done for women with syphilis during pregnancy, you know, as really c- because the penicillin's the only recommended treatment, which we've mentioned before, and obviously for congenital syphilis as well.

So that's what we've done in our hospital.

We've restricted the use of, of benzathine penicillin only for pregnant women and only for babies with congenital syphilis to make sure we have enough supply.

So the, the real question is: What do you do if, if you can't get ahold of benzathine penicillin? W- And, and I think this is the bigger s- the bigger challenge is the non-pregnant patients and the men, um, the males who have, who have syphilis.

What are we doing for those people 'cause we don't have the benzathine, benzathine penicillin for them? So in p- in places, y- you can use doxycycline, uh, f- for men and also for non-pregnant women, uh, and that's a way to preserve your, your, uh, benzathine penicillin supplies.

Uh, doxycycline, uh, Mariana, we've talked about doxy PEP before, uh, and that's an important piece, too, which I c- I'll mention later, but this is, like, for treatment.

So there, there's, there's two different dosing regimens.

They're both 100 milligrams twice a day.

Uh, but one of them is a 14-day, and that's for early syphilis.

And then if you have somebody with late latent syphilis or latent syphilis of unknown duration, so if you're not sure about that, then you would extend out to 28 days.

So it's either a 14-day, so 28 capsules, or 56 capsules for 28 days will be your doxycycline dosing, depending on, on how you stage them.