Judicious Use of Benzathine Penicillin G in Response to a Medication Shortage Alert

Document Type

Conference Proceeding

Publication Date

1-29-2025

Publication Title

Open Forum Infect Dis

Abstract

Background. The national shortage of benzathine penicillin G (BPG) poses challenges in the treatment of syphilis. In response to this critical BPG shortage, our health system implemented a medication shortage alert within the electronic health record (EHR). The alert provides recommendations to optimize BPG utilization. This study investigates the impact of the BPG drug shortage on clinical practice. Methods. This was an IRB-approved, retrospective cohort study focusing on patients >3 months who received BPG between 5/9/23-2/28/24. The study included inpatient and outpatient visits after implementing the medication shortage alert. Exclusions were applied for severe penicillin allergy, neurosyphilis, or congenital syphilis. Two cohorts were analyzed: the judicious BPG group (patients with primary, secondary, or latent syphilis receiving BPG), and the non-judicious group (patients receiving BPG for alternative diagnoses). The study assessed social determinants of health (SDOH) as primary outcomes and compared a separate cohort of syphilis patients receiving BPG or alternative therapy (e.g., doxycycline). Results. 453 patients were included. Majority of patients were non-Hispanic Black (273, 60%) men (272, 60%), with a median age of 32 years (IQR: 22-44). Of these patients, 318 (70%) received judicious BPG, while 135 (30%) received non-judicious BPG. The most common non-judicious diagnosis was streptococcal pharyngitis (128, 95%). In multivariable logistic regression (Table 1), variables associated with judicious use included: age >32 years (adjOR: 2.273; 95% CI: 1.488-3.472), male sex at birth (adjOR: 1.835; 95% CI: 1.206-2.792), and black race (adjOR: 1.847; 95% CI: 1.212-2.815). Among a cohort of 128 syphilis patients who received either BPG (64, 50%) or doxycycline (64, 50%) treatment, those who received doxycycline were more likely to lack health insurance (35 [54.7%] vs. 43 [67.2%], p=0.15) and receive outpatient treatment (3 [4.7%] vs. 12 [18.7%], p=0.13) (Table 2). SDOH data were reported in < 50% of patient charts. Conclusion. Despite implementing an EHR drug shortage alert, 30% of BPG use was suboptimal and mostly for pharyngitis. Optimizing SDOH documentation represents an opportunity to assess health inequities and the impacts on patient outcomes for syphilis management.

Volume

12

First Page

S898

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