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Key messages
- There is an ongoing national shortage of Pfizer Bicillin L-A 600,000 unit prefilled syringes for injections. The estimated return to supply date is August 2025.
- The shortage of the Pfizer Bicillin L-A 1.2 million unit prefilled syringes for injections has resolved.
- Bicillin is used in the management of conditions such as syphilis, acute rheumatic fever/rheumatic heart disease and other group A streptococcal diseases.
- The ongoing shortage of the 600,000 unit prefilled syringes may affect the treatment of paediatric patients.
- The Therapeutic Goods Administration approved the importation of a second overseas-registered product, Extencilline benzathine benzylpenicillin 1.2 million unit vial (France) under Section 19A of the Therapeutic Goods Act 1989. This approval has now expired but stock may still be available in pharmacies.
- Since 1 April 2024, the Extencilline benzathine benzylpenicillin product has been subsidised by the Pharmaceutical Benefits Scheme.
- The Extencilline benzathine benzylpenicillin products require reconstitution and have different administration instructions to Bicillin L-A pre-filled syringe.
- Clinicians, pharmacies and health services providing care to patients with conditions that typically require treatment or prevention with benzathine benzylpenicillin are recommended to stay up to date on the ongoing shortage situation, closely monitor their medication stock and order quantities based on current needs and forecasted usage. Consider the use of alternative antibiotic agents in suitable patients.
- Where benzathine benzylpenicillin is the only suitable medication for a patient and there are difficulties with access to supply, clinicians and health services are recommended seek advice from their Local Public Health Unit.
Information on the Section 19A benzathine benzylpenicillin products
Extencilline benzathine benzylpenicillin (France)
The Therapeutic Goods Administration approved the importation and supply of the overseas-registered Extencilline benzathine benzylpenicillin 1.2 million unit vial (France) product in Australia under Section 19A of the Therapeutic Goods Act 1989. From 1 April 2024, this medication is subsidised by the Pharmaceutical Benefits Scheme.
The Extencilline benzathine benzylpencillin 1.2 million unit vial (France) product can be used as an alternative medication to Pfizer Bicillin L-A prefilled syringes in the treatment and prevention of conditions such as syphilis, acute rheumatic fever / rheumatic heart disease and other group A streptococcal diseases. Both Pfizer Bicillin L-A and Extencilline product contain long-acting benzathine benzylpenicillin. The recommended dose and frequency for these conditions are unchanged with the Extencilline product, which is considered safe for people of all ages and for use in pregnancy and breastfeeding.
It is important to note that there are differences in the presentation, storage, additional excipients and administration of Extencilline benzathine benzylpenicillin product compact to Pfizer Bicillin L-A. Notably, the Extencilline benzathine benzylpenicillin product must be reconstituted and results in a larger administration volume.
In Australia, the Entencilline benzathine benzylpenicillin product is being ordered and supplied by Orspec Pharma.
Additional resources
For more information on the Bicillin L-A shortage, see:
- Therapeutic Goods Administration: About the 2024-2025 shortage of Bicillin L-A (benzathine benzylpenicillin tetrahydrate) prefilled syringe for
- Therapeutic Goods Administration: Medicine Shortages Information
For more information on the use of the Section 19A benzathine benzylpenicillin product, see:
- Australian Commission on Safety and Quality in Health Care - Safety considerations during benzathine benzylpenicillin (Billin L-A) supply disruption - Fact
- Rheumatic Health Disease Australia: S19A EXTENCILLINE product - Clinical guide for
- Australian Injectable Drugs Handbook: AIDH - Login
For more information on alternative antibiotic agents, refer to the Australian Therapeutic , relevant condition-specific guidelines and/or infectious disease specialists for advice.
Reviewed 11 April 2025