Infectious disease experts have warned that the shortage of antibiotics, specifically a type of penicillin used for syphilis, could worsen the sexually-transmitted infection's (STI) epidemic in the United States.
Pharmaceutical giant Pfizer announced in a June 12 letter that the long-acting injectable antibiotic Bicillin L-A, formally penicillin G benzathine, currently has low supply. The same problem also applied to another kind of antibiotic called penicillin G procaine.
According to the company, the shortages were caused by a significant increase in demand triggered by the rising rate of syphilis infections. Bicillin's recent use as an alternative to the more common amoxicillin was also cited as another reason for the shortages. Prescribed for more general infections like strep throat, amoxicillin has had periodic shortages.
Pfizer spokesman Steven Danehy said it will likely take the company's plant in Rochester, Michigan a year to increase production by 50 percent – and ultimately manufacture enough of the antibiotic to meet demand and shore up reserves. (Related: FDA: Basic antibiotics shortage ongoing since Q4 last year, some medicines to completely run out by end of June.)
The Drug manufacturer also warned that its supply of a rarely-used pediatric version of Bicillin would soon run out as the company had utilized that drug's production line for the adult formula. An increase in strep throat cases prompted doctors to resort to Bicillin in lieu of amoxicillin.
According to figures from the Centers for Disease Control and Prevention (CDC), syphilis has been on the rise in the U.S. since 2000. A total of 176,713 cases were recorded in 2021 – an almost 75 percent increase since 2017.
People who contract Treponema pallidum, the pathogen responsible for the STI, develop sores and a rash. If left untreated, syphilis can seriously damage the body and even lead to death.
The CDC also noted that among adult syphilis cases, nearly one-fourth are in women. Homosexual men comprised just under a third of syphilis infections, while about one-fifth were reported among heterosexual men.
Shortages undermine efforts against congenital syphilis
Congenital syphilis, which involves the mother passing the disease on to her child while in the womb, is also another concern. It has a high fatality rate and can also lead to preterm birth and severe birth defects. Between 2017 and 2021, congenital syphilis tripled to 2,855 cases – including 220 infant deaths.
Bicillin is the only recommended treatment for pregnant women infected with T. pallidum. If provided early enough, it is very effective at preventing transmission to the fetus. But given the shortage of the antibiotic, the CDC has urged doctors to give preference to pregnant patients and infected or exposed infants when administering it.
The public health agency also recommended doxycycline, another antibiotic, for two to four weeks depending on the disease stage. However, experts are worried that some might have trouble taking doxycycline – potentially compromising its effectiveness.S
"It worries me that these moms may not have access to life-saving medication," said Dr. Anita Henderson, a pediatrician in Hattiesburg, Mississippi. According to her, the Magnolia State had seen large increases in congenital syphilis cases over the last five years.
Dr. Jeffrey Klausner, an infectious disease expert at the University of Southern California, said alternatives to the antibiotic for pregnant women are under development and review. However, these alternatives are years away from becoming available.
"Most drug companies have not been particularly keen on developing antibiotics, in part because the profit margin for this class of drugs is typically far lower than the next blockbuster drug that could be worth billions of dollars," DNYUZ remarked.
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