Bicillin C-R is indicated for streptococcal infections of the skin and respiratory tract; however, its efficacy in treating syphilis is unknown.
Five BPG-containing products are marketed by Monarch: Bicillin L-A, Bicillin[R] L-A Pediatric (0.6 MU BPG), Bicillin C-R, Bicillin[R] C-R Pediatric (a mixture of 0.3 MU BPG and 0.3 MU procaine penicillin G), and Bicillin[R] C-R 900/300 (a mixture of 0.9 MU BPG and 0.3 MU procaine penicillin G).
During January 1999-March 2004, a total of 429 patients were treated with Bicillin C-R for confirmed syphilis infection at the clinic.
Clinic staff attempted to reach syphilis patients and contacts treated with Bicillin C-R by letter, up to three telephone calls, and, if necessary, telephone calls to emergency contacts listed on medical records.
and the Food and Drug Administration are warning physicians about the inappropriate use of Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) for the treatment of syphilis.
The company has received postmarketing reports from several STD clinics in the United States where Bicillin C-R was used instead of Bicillin L-A to treat patients with syphilis.
The company is changing the packaging and syringe labels of Bicillin C-R to highlight the distinction between that product and Bicillin L-A.
The Maryland Department of Health investigated a clinic in which 63 patients might have received Bicillin C-R, a low-dose penicillin G preparation that is not recommended for syphilis, rather than the correct treatment of Bicillin L-A, between January and October of 1998.
Of 55 state and city STD programs later surveyed by the CDC, 5 reported unintentional use of Bicillin C-R at least once between 1993 and 1998.
The inadvertent use of Bicillin C-R, which contains only half the recommended dose of BPG for syphilis, was recognized by a health-care provider at the STD clinic in a neighboring county (county B) approximately 1 month after county B had borrowed BPG from county A.
Three BPG-containing products are marketed by Wyeth-Ayerst Laboratories (Philadelphia, Pennsylvania): Bicillin L-A, Bicillin C-R, and Bicillin(r) C-R 900/300 (a mixture of 0.9 MU BPG and 0.3 MU procaine penicillin G).
To identify patients who might have been treated with Bicillin C-R at county A's STD clinic, investigators reviewed the clinic's invoice records and the penicillin injection log.