BENZATHINE BENZYLPENICILLIN (BICILLIN L-A) - UPDATE

Affected Protocols

Standard Treatment Manual

  • STI Management p281, 289,
  • Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) p295, p296
  • Antibiotics Table p427

Women’s Business Manual

  • STI Management for Women p248, 257
  • Antibiotics Table p366

Issue

  • Benzathine benzylpenicillin (Bicillin L-A) is also referred to as benzathine penicillin (penicillin G)
  • Benzathine benzylpenicillin doses are expressed in mg/mL however with the changes to formulation they are now expressed in Units/mL:
    • 1,200,000U/2.3mL = 900mg.
  • Of most concern is the role of benzathine benzylpenicillin (Bicillin L-A) in the treatment of two very serious conditions – syphilis and rheumatic heart disease. The RPHCM editorial committee has authorised these stickers to ensure no confusion is associated with the manufacturer’s changes and the dose is accurately dispensed.

Action

  • The dose per pre-filled syringe remains the same: 1,200,000U/2.3mL (900mg).
  • New pre-filled syringe half dose available soon: 600,000U/1.17mL (450mg)

Online manual

Protocols affected in the online version of the manuals have been notated to accommodate these changes.

Update hard copy manual

Stickers to explain this situation will be supplied with new orders of the Standard Treatment Manual and the Women's Business Manual. 

Stickers are to be applied to the manual/s and are designed to clarify changes to the packaging and formulation of benzathine benzylpenicillin (Bicillin L-A) made by the manufacturer (Pfizer) after the RPHCM went to print.

  • The first sticker is a general alert about the changes and can be placed on the front cover or in the front of the manual concerned.
  • The second sticker is to update the benzathine benzylpenicillin (or benzathine penicillin) entry in the Antibiotics doses table on page 426 of the STM, and page 366 of the WBM. The doses are unchanged but are now expressed in units/mL.

A copy of the Sticker template is available here. [NB: Print at Actual Size]

Supporting information

These changes were made by Pfizer, the only supplier of benzathine benzylpenicillin (Bicillin L-A) in Australia.