Alabama Department of Public Health
Alabama Emergency Response Technology (ALERT)
Health Alert Network (HAN)
July 21, 2025

Penicillin G Benzathine Injectable Suspension (Bicillin L-A®) Pfizer Recall and Anticipated Shortage in Alabama

Key Message:
On July 10, 2025, Pfizer announced a voluntary recall of certain lots of penicillin G benzathine injectable suspension (Bicillin® LA - URGENT: DRUG RECALL), because of particulates identified during visual inspection. Pfizer anticipates a near-term stockout for Bicillin® L-A 1.2 million Units/2 mL (600,000 units/mL) and 2.4 million Units/4 mL (600,000 units/mL) prefilled syringes. To date, Pfizer has not received reports of any adverse events associated with this issue.

Key Facts:
ADPH is monitoring the situation actively with the goal of maintaining sufficient statewide supply for treatment of syphilis, prioritizing pregnant individuals and infants, because injectable long- acting benzathine penicillin G is the only acceptable treatment for syphilis in pregnancy and infants exposed to syphilis. Individuals who are symptomatic, sexual partners of pregnant individuals, incarcerated, and substance use disorder should be prioritized for treatment with injectable long-acting benzathine penicillin G.  

ADPH Recommends the Following Priority Actions:

• Review communication from Pfizer to assess if your medication lots are affected: Bicillin® LA URGENT: DRUG RECALL.
• Assess your organizational supply, forecast your need, and reserve sufficient injectable long-acting benzathine penicillin G. Reach out to your distributors and to Pfizer directly, to state your need for additional medication if necessary.
• Evaluate organizational capacity to buy and dispense Lentocilin© and Extencilline, two alternative formulations that were approved by FDA for temporary importation because of prior shortages.
• Choose doxycycline for treatment of non-pregnant people with syphilis to help preserve injectable long-acting benzathine penicillin G supplies for pregnant patients and infectious partners. See CDC’s treatment recommendations for more information. Individuals treated with doxycycline should have a test of cure at 3 and 6 months. 
• Institute systems-level approaches to steward the use of injectable long-acting benzathine penicillin G and encourage the use of alternative antimicrobials for other infectious diseases.
• Accurately stage syphilis infections to ensure appropriate dosing of antimicrobials. Clinicians with questions about syphilis clinical management should review the CDC 2021 STI Treatment Guidelines, or contact an infectious diseases specialist, the ADPH Division of STD at 334-206-5350, or the National Network of STD Clinical Prevention Training Center (NNPTC) STD Clinical Consultation Network.
• If you cannot get injectable long-acting benzathine penicillin G to treat pregnant patients or their contacts, contact the ADPH Division of STD at 334-206-5350.
• Report syphilis and congenital syphilis cases immediately online at https://epiweb.adph.state.al.us/redcap/surveys/?s=H37ENP8ADD or call ADPH STD Division at 334-206-5350.

ADPH offers free syphilis testing and treatment for pregnant women and their partners. For more information, visit https://www.alabamapublichealth.gov/std/prenatal-std-testing.html.