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Bicillin L-A is a long-acting penicillin given by intramuscular injection 2 to 3 times weekly.
Bicillin L-A is recommended for treating syphilis and upper respiratory tract infections caused by susceptible streptococci (2).
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).
Therefore, whether treatment failures that occurred among those treated with Bicillin C-R represent an excess over what would be expected had they been treated with Bicillin L-A cannot be determined without additional data.
Bicillin L-A (penicillin G benzathine injectable suspension) is the only currently approved penicillin G benzathine product indicated for use in sexually transmitted infections such as 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.
Yet 56% of the survey respondents were unaware of the potential confusion between Bicillin C-R and Bicillin L-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).
During December 1997-May 1998, 150 doses of Bicillin C-R were shipped to county A's STD clinic after orders for Bicillin L-A were placed by telephone.
Although the five pregnant women were located and treated with Bicillin L-A, four infants were treated for congenital syphilis because their mothers had not been treated adequately at least 30 days before delivery.