savebabe
Frequent Contributor (1K+ posts)
Member # 9847
posted
I just tried to get and order for 1.2 ml of bicillin, but my pharmacist told me there was a hold on the drug. Has anybody else had this problem? Are they still prescribing the higher doses?
Posts: 1603 | From ny | Registered: Aug 2006
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posted
When I saw my LLMD two weeks ago, he said there was a nationwide shortage of bicillin.
Posts: 16 | From Ohio | Registered: Sep 2006
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savebabe
Frequent Contributor (1K+ posts)
Member # 9847
posted
I also heard there was no release date. Is their an alternative to bicillin?
Posts: 1603 | From ny | Registered: Aug 2006
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savebabe
Frequent Contributor (1K+ posts)
Member # 9847
posted
Found the problem.
Home > Drug Shortages > Penicillin G Injection
Penicillin G Injection 27 April 2006
Products affected--description
Penicillin G benzathine/Penicillin G procaine suspension (Bicillin C-R), 300,000 unit/mL / 300,000 unit/mL, King Pharmaceuticals 1 mL syringes, 10/package, 61570-0139-10 2 mL syringes, 10/package, 61570-0141-10 2 mL syringes, 10/package (21 guage), 61570-0140-10 4 mL syringes, 10/package, 61570-0142-10
Penicillin G benzathine / Penicillin G procaine suspension (Bicillin C-R 900/300 Pediatric), 900 unit/mL / 300 unit/mL, King Pharmaceuticals 2 mL syringes, 10/package (1 1/4 inch needle), 61570-0143-10 2 mL syringes, 10/package (1 inch needle), 61570-0144-10
Penicillin G benzathine suspension (Bicillin L-A), 600,000 unit/mL, King Pharmaceuticals 1 mL syringes, 10/package, 61570-0146-10 2 mL syringes, 10/package, 61570-0147-10 4 mL syringes, 10/package, 61570-0148-10
Reasons for the shortages
Pfizer was unable to supply penicillin G injection due to manufacturing difficulties.1 Sandoz now has adequate supplies of penicillin G injection.2 The company was previously allocating product.2 Penicillin G suspension products (Bicillin L-A, Bicillin C-R) products are available for emergency situations. 3 Estimated resupply dates
Pfizer has all products available.1 Sandoz has both penicillin G potassium and penicillin G sodium available. However, pharmacies are encouraged to contact their specific wholesaler or distributor to determine whether product is currently in stock.2 Baxter has frozen bags of penicillin G available in 1 million unit, 2 million unit, and 3 million unit sizes.4 King states that all Bicillin C-R and Bicillin L-A products arein short supply. The company is allocating stock for emergencies. Wholesalers must fax emergency orders to the company.3 The company has no supply of the Bicillin C-R Adult 2 mL presentation with a 1 1/4 inch needle (NDC 61570-0143-10) and estimates supplies will be available third quarter of 2006. Bicillin C-R Pediatric 2 mL with a 1 inch needle (NDC 61570-0144-10) is available for emergencies. The Centers for Disease Control and Prevention (CDC) has worked with King to establish a procedure for obtaining Bicillin L-A when wholesalers have insufficient stock. This procedure is available at http://www.cdc.gov/std/syphilis/BicillinLA8-22-05.pdf. Wholesalers should contact Joel Newton of King Pharmaceuticals (423-990-8373) if supplies are not sufficient. Hospitals may contact Joel Newton directly for medical emergencies when wholesalers have been unsuccessful in obtaining product. Implications for patient care
Penicillin G for injection
Penicillin G injection is labeled for the treatment of severe infections caused by penicillin-susceptible microorganisms when rapid and high penicillin levels are required.5 Penicillin G is used in streptococcal infections, pneumococcal infections, anthrax, actinomycosis, clostridial infections including tetanus and botulism, diphtheria, erysipeloid endocarditis, fusospirochetal infections, gram-negative bacillary infections, listeria infections, pasteurella infections, rat-bite fever, disseminated gonococcal infections, syphilis including congenital and neurosyphilis, and meningococcal meningitis.5,6 Penicillin G injection may also be used to treat Lyme disease.6-8 During a shortage, use alternative antimicrobial agents when appropriate.5-7
Penicillin G Suspensions
Penicillin G Benzathine (Bicillin L-A) is used for the treatment of syphilis, and either treatment of mild to moderate infections or prophylaxis against infections caused by organisms susceptible to low concentrations of penicillin.8 Penicillin G Benzathine / Penicillin G Procaine (Bicillin C-R) is used to treat streptococcal infections in selected situations.8 Safety
Clinicians must take extra care to ensure patients receive accurate doses during this shortage. For example, if a patient requires a 5 million unit dose, and the institution only has 2 and 3 million unit pre-mixed doses available, ensure the patient receives the entire dose. Penicillin G suspension products (Bicillin L-A, Bicillin C-R) are not for intravenous use. Alternative Agents and Management
Intravenous penicillin G is considered the treatment of choice for congenital syphilis, neurosyphilis, and for prevention of perinatal Group B streptococcal disease.10 Institutions should consider reserving penicillin G injection for use in these cases. Intramuscular penicillin therapy may be an option for some patients.10 In 1999, the Centers for Disease Control and Prevention (CDC) provided guidelines for a nationwide penicillin shortage.10 Table 1 incorporates these CDC recommendations and provides alternatives for selected situations. Table 1. Alternatives to Penicillin G Injection in Selected Situations9
Situation Recommendation Comments
Infants with clinical or laboratory evidence of congenital syphilis Procaine penicillin G 50,000 units /kg/dose IM once daily for 10 days.10,11
Ampicillin 50 mg/kg/dose IV every 6 hours for 10-14 days.10
Ceftriaxone:10 For infants < 30 days old: 75 mg/kg/day IV or IM in a single dose for 10-14 days. For infants > 30 days old: 100 mg/kg/day IV or IM in a single dose for 10-14 days. There is not strong evidence to support the use of ampicillin or ceftriaxone. Careful clinical and serologic follow-up is needed. The CDC recommends consultation with an expert in the treatment of infants with congenital syphilis. Management may include a repeat CSF exam at 6 months of age if the initial exam was abnormal. Use ceftriaxone with caution in infants with jaundice.
Infants at risk for congenital syphilis without any clinical or laboratory evidence of infection Procaine penicillin G 50,000 units/kg/dose IM once daily for 10 days.10,11
Benzathine penicillin G 50,000 units/kg IM as a single dose.10 For premature infants who may not tolerate IM injections because of decreased muscle mass, IV ampicillin or ceftriaxone may be considered with careful clinical and serologic follow-up. Adjust doses of ampicillin and ceftriaxone according to the level of prematurity.
Neurosyphilis Procaine penicillin G 2.4 million units IM daily for 10 to 14 days plus probenecid 500 mg four times per day for 10 to 14 days.9,10 For patients who cannot tolerate IM procaine penicillin, IV ampicillin 3 to 4 grams per dose every 6 hours for 10 to 14 days or ceftriaxone 2 grams IV per day for 10 to 14 days may be considered with careful clinical and serologic follow-up and with the consultation of an expert in treating neurosyphilis.
Perinatal Group B streptococcal disease prophylaxis Ampicillin 2 g IV initially, then 1 g IV every 4 hours until delivery.9,10 Patients with penicillin allergy but a low risk of anaphylaxis may receive cefazolin 2 g IV initially, then 1 g IV every 8 hours until delivery.8 Patients with cultures susceptible to clindamycin my alternatively receive clindamycin 900 mg IV every 8 hours until delivery.8
Infants with meningitis secondary to Group B streptococcal infection Age < 7 days: ampicillin 200 to 300 mg/kg/day IV in 3 divided doses.9 Age > 7 days: ampicillin 300 mg/kg/day IV in 4 to 6 divided doses.9 Clinicians may wish to consult with a pediatric infectious disease clinician.
Posts: 1603 | From ny | Registered: Aug 2006
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posted
There is a shortage of the drug and the company (Monarch/King Pharma) is only releasing the drug to patients in need. Your pharmacist needs to call Monarch/King at (800) 776-3637 and the company will fax the pharmacy a form that indicates the patient's needs. Basically because supply is limited until they can get their production sorted out, they are only giving the drugs to patients who need it (lyme is considered a need) so that pharmacies aren't stocking their shelves needlessly.
I fill my RXes at CVS and they were able to get this for me last week.
Posts: 98 | From MA | Registered: Dec 2005
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posted
there is no real alternative to Bicillin available in the US. Another option would be to try calling a hospital pharmacy - they might have some Bicillin in stock because they are more likely to use it.
Posts: 98 | From MA | Registered: Dec 2005
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savebabe
Frequent Contributor (1K+ posts)
Member # 9847
posted
Thank for the reply. I am going to try this again tomorrow. Is anything about having lyme disease easy?
Posts: 1603 | From ny | Registered: Aug 2006
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posted
Try a small independent pharmacy. We were able to get them this way and they ordered a 3 month supply for us. Hope this helps.
Posts: 488 | From NY | Registered: Oct 2004
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posted
I get mine at WalMart and it takes about a week from the time I call it in for them to get it. Their supplier has it so it's not a problem.
The pharmacist told me he knew about Lyme and all the complications it can cause. He's very willing to help and calls me at home when the Bicillin comes in.
I live in the Central Valley of California and can only speak for my local WalMart but it might be worth a try if you have one near you.
I pay $475 out of pocket for 10 tubex syringes.
Posts: 105 | From CA | Registered: Apr 2005
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posted
Hi The pharmacy by Dr. B's office, east Hampton Pharmacy, has a very large supply. i think the website is easthamptonpharmacy.com, they accept my insurance and mail all over the country
savebabe
Frequent Contributor (1K+ posts)
Member # 9847
posted
Thanks everyone!
I was able to get my shots through a small pharmacy using all your information. Although, my insurance company will not cover it. Once again, has anybody else have this problem? Thanks
Posts: 1603 | From ny | Registered: Aug 2006
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Jill E.
Frequent Contributor (1K+ posts)
Member # 9121
posted
My insurance won't pay a dime and I've appealed and lost so far.
There have been many posts about Bicillin, insurance not paying, etc. if you want to do a search.
But some Lyme patients' insurance plans do pay. I've found that my Lyme pals who have group insurance tend to have a better chance of getting it paid for than those of us with individual insurance plans - but I can only speak for the patients I know personally.
It's expensive when you pay out of pocket like many of us do!
Jill
-------------------- If laughter is the best medicine, why hasn't stand-up comedy cured me? Posts: 1773 | From San Diego | Registered: Apr 2006
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timaca
Frequent Contributor (1K+ posts)
Member # 6911
posted
Glad you got the bicillin. You need to check your individual insurance plan (read it yourself) to see what it covers and what it does not. Mine does cover injectable drugs 100%, so the bicillin is supposedly covered 100%. Of course, I'm still paying for it, and having to work with my state insurance commission to get reimbursed, but I should get it totally covered.
You need to see what YOUR policy says with regard to bicillin. This means you have to get a copy of your policy and read it.
Good luck.
Timaca
Posts: 2872 | From above 7,000 ft in a pine forest | Registered: Feb 2005
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posted
Myson's insurance denied this, He was fortunate the company he works for said the woudl pay if they could not get insurance to pay.
Posts: 488 | From NY | Registered: Oct 2004
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