About the shortage of Bicillin L-A (benzathine benzylpenicillin tetrahydrate) prefilled syringe for injection

Summary

• Bicillin L-A prefilled syringe for injection products are in shortage until 30 November 2026.
• Bicillin L-A 1.2 million unit prefilled syringe for injection is now available as emergency stock only. 
• Bicillin L-A 600,000 unit prefilled syringe for injection remains unavailable until 30 November 2026.
• Overseas-registered benzathine benzylpenicillin products are approved for supply until 31 January 2027 under section 19A of the Therapeutic Goods Act 1989.
• Benzathine benzylpenicillin products should be prioritised for use in high-priority patient groups, based on previous advice from clinical experts (see Information for healthcare professionals below). 

Benzathine benzylpenicillin is a specialised injectable antibiotic which is used in the treatment of bacterial infections including rheumatic fever, syphilis and group A streptococcal infections of the throat and skin. It is also used to prevent serious conditions that follow these infections such as rheumatic heart disease, congenital syphilis and acute post-streptococcal glomerulonephritis (APSGN). 

Benzathine benzylpenicillin plays a significant role in rural and remote community health care, and we acknowledge the critical importance of this medicine to First Nations people. 

Supply of Bicillin L-A prefilled syringe for injection products

Pharmaceutical company Pfizer Australia has told us that both Bicillin L-A prefilled syringe for injection products will remain in shortage until 30 November 2026. 

Bicillin L-A 1.2 million unit prefilled syringe for injection is now available as emergency supply only. Healthcare professionals can contact Pfizer Australia directly on 1800 675 229 for ordering information.

Bicillin L-A 600,000 unit prefilled syringe for injection remains unavailable until 30 November 2026. 

Alternative products approved to support supply

To help cover supply gaps, we have approved the supply of overseas-registered alternative benzathine benzylpenicillin products under section 19A of the Therapeutic Goods Act 1989 until 31 January 2027. 

• Lentocilin S 1200 benzathine benzylpenicillin 1,200,000 IU/4 mL powder and solvent for suspension for injection (Portugal) is subsidised on the Pharmaceutical Benefits Scheme (PBS). Call the approval holder, Neon Healthcare, on (02) 7255 8455 to order this product.
• Benzylpenicillin benzathine 1.2 million IU powder for suspension for injection (Brancaster Pharma, UK). Call the approval holder, Pro Pharmaceuticals Group, on 1300 077 674 to order this product. 
• Benzetacil benzathine benzylpenicillin 1,200,000 IU powder and solvent for suspension for injection (Spain). Call the approval holder, Phero Pharma, on 02 9420 9199.

Up-to-date details about these shortages are also available at the medicine shortage reports database- external site. 

Reconstitution advice 

Please note that overseas-registered benzathine benzylpenicillin products may require reconstitution before administration or may have different administration instructions to the Australian-registered Bicillin L-A prefilled syringe products.  

The Australian Commission on Safety and Quality in Health Care (ACSQHC) and the Australian Injectable Drugs Handbook (AIDH) have each developed resources to assist healthcare professionals in the use of overseas-registered alternative products:

• ACSQHC Fact Sheet- external site
• AIDH monograph- external site. 

Please note the above resources may not reflect all products currently approved under section 19A.

Information for patients and carers

If you or someone you care for is unable to access Bicillin L-A prefilled syringe products, you should consult your treating healthcare professional for advice. They may prescribe a different brand of benzathine benzylpenicillin or a different antibiotic.

Important allergen information for benzathine benzylpenicillin products: 

Bicillin L-A and the following overseas-registered products approved under section 19A contain lecithin (source unavailable) or soy lecithin and are not suitable for patients with an allergy to soy or peanuts:

• Lentocilin S 1200 benzathine benzylpenicillin 1,200,000 IU/4 mL powder and solvent for suspension for injection (Portugal)
• Benzylpenicillin benzathine 1.2 million I.U powder for suspension for injection (Brancaster Pharma, UK)
• Benzetacil benzathine benzylpenicillin 1,200,000 IU powder and solvent for suspension for injection (Spain)

Lentocilin S 1200 benzathine benzylpenicillin 1,200,000 IU/4 mL powder and solvent for suspension for injection (Portugal) is packaged together with an amber ampoule of diluent that contains lidocaine hydrochloride. This diluent is not suitable for patients with allergies to lidocaine.

Your healthcare professional should determine if the prescribed alternative medicine is suitable for you. 

Information for healthcare professionals

Pharmaceutical company Pfizer has told us that Bicillin L-A 1.2 million unit prefilled syringe for injection is now limited to emergency supply only. Healthcare professionals can contact Pfizer Australia directly on 1800 675 229 for ordering information. 

Bicillin L-A 600,000 unit prefilled syringe for injection remains unavailable until 30 November 2026. 

As Bicillin L-A prefilled syringe products are available in packs of 10, consider prescribing or supplying in quantities aligned with immediate clinical need, such as 1 to 2 dosage units, depending on the indication being treated. This will help to support equitable access until supply returns to full capacity.  

To ensure that the supply of Bicillin L-A prefilled syringe products is conserved for the treatment of high-priority patient groups, please use the following advice, which was developed and endorsed by clinical experts during the previous shortages of benzathine benzylpenicillin in 2023:

Products containing benzathine benzylpenicillin should be prioritised for use in the following conditions: 

• Treatment and secondary prophylaxis of acute rheumatic fever (ARF), and secondary prophylaxis of rheumatic heart disease (RHD).
• Patients who require treatment for group-A streptococcal infection of the respiratory tract and skin who are at high risk of acute rheumatic fever, rheumatic heart disease or acute poststreptococcal glomerulonephritis (APSGN), where oral therapy is not acceptable or the likelihood of non-adherence is high.
• Treatment for syphilis in proven or suspected cases, or if identified as a sexual contact of syphilis.

Where patients fall outside the above priority conditions and settings, prescribers should refer to the Australian Therapeutic Guidelines, appropriate local guidelines and/or infectious disease experts for advice on alternative antibiotic agents.

To help cover supply gaps, we have approved the supply of overseas-registered alternative benzathine benzylpenicillin products under section 19A of the Therapeutic Goods Act 1989 until 31 January 2027.

• Lentocilin S 1200 benzathine benzylpenicillin 1,200,000 IU/4 mL powder and solvent for suspension for injection (Portugal) is subsidised on the Pharmaceutical Benefits Scheme (PBS). Call the approval holder, Neon Healthcare, on (02) 7255 8455 to order this product.
• Benzylpenicillin benzathine 1.2 million I.U powder for suspension for injection (Brancaster Pharma, UK). Call the approval holder, Pro Pharmaceuticals Group, on 1300 077 674 to order this product.
• Benzetacil benzathine benzylpenicillin 1,200,000 IU powder and solvent for suspension for injection (Spain). Call the approval holder, Phero Pharma on 02 9420 9199.

Information about section 19A approvals is published on the Section 19A approvals database.

Reconstitution and administration instructions may differ for overseas-registered benzathine benzylpenicillin products. Please refer to the above links to the ACSQHC factsheet and AIDH monograph or, alternatively, to the corresponding overseas product information for instructions about reconstitution and administration.

Important allergen information relating to benzathine benzylpenicillin products: 

Bicillin L-A and the following overseas-registered products approved under section 19A contain lecithin (source unavailable) or soy lecithin and are not suitable for patients with an allergy to soy or peanuts:

• Lentocilin S 1200 benzathine benzylpenicillin 1,200,000 IU/4 mL powder and solvent for suspension for injection (Portugal)
• Benzylpenicillin benzathine 1.2 million I.U powder for suspension for injection (Brancaster Pharma, UK)
• Benzetacil benzathine benzylpenicillin 1,200,000 IU powder and solvent for suspension for injection (Spain)

Lentocilin S 1200 benzathine benzylpenicillin 1,200,000 IU/4 mL powder and solvent for suspension for injection (Portugal) is packaged together with an amber ampoule of diluent that contains lidocaine hydrochloride. This diluent is not suitable for patients with allergies to lidocaine.  

Prior to prescribing, healthcare professionals should determine if the overseas-registered product is suitable for the patient. 

To support ongoing supply, please order quantities based on your current needs and do not stockpile these products. 

General information

Please note that the return-to-supply dates we have published here may change and you should check the medicine shortage reports database- external site for updates.

Please also note we can suggest approaches to manage the supply of medicines during shortages, but do not regulate the clinical decisions of health professionals.

We will continue to work with Pfizer Australia to monitor the supply of Bicillin L-A prefilled syringe products and will update this advice as needed.