Availability of Benzathine Penicillin G for Syphilis Treatment in Shandong Province, Eastern China

Background: Penicillin is still an essential antibiotic for the treatment and prevention of syphilis. The shortage of benzathine penicillin G (BPG) worldwide presents a major challenge in the penicillin treatment of syphilis. Its availability for syphilis treatment has not been adequately evaluated in China. Methods: Two surveys were conducted among hospitals providing sexually transmitted infection clinical services in Shandong Province in 2012 and 2018. Data on the basic information and BPG availability of the surveyed hospitals and related factors were collected and analyzed using SPSS 17·0. Findings: A total of 433 and 515 hospitals were surveyed in 2012 and 2018, respectively. A significant difference in BPG availability was observed among different levels and types of hospitals both in 2012 (X2=9·747, p=0·008; X2= 37·167, p=0·000) and 2018 (X2=11·775, p=0·003; X2= 28·331, p=0·000). The BPG availability among surveyed hospitals increased from 45·0% in 2012 to 56·4% in 2018 (X2=11·131, p=0·001). The BPG availability was higher in 2018 than in 2012 among county-level hospitals (52·0% vs. 40·8%, X2=7·783, p=0·005), general western medicine hospitals (62·1% vs. 50·0%, X2=6·742, p=0·009), maternal and child health hospitals (57·1% vs. 26·9%, X2=13·906, p=0·000), and public hospitals (56·8% vs. 45·0%, X2=11·361, p=0·001). However, the county-level availability of BPG (at least one hospital has BPG in a county-level unit) has not improved between 2012 and 2018 (65·93% vs. 70·34%; X2=0·563, p=0·453). The absences of clinical needs, restriction of clinical antibacterial drugs, and lack of qualifications for providing syphilis treatment were the major reasons for the low BPG availability of hospitals. Interpretation: The BPG availability for syphilis treatment in Shandong Province has been improved in recent years, although it remains low and presents disparities among different levels and types of hospitals. Its low availability for syphilis treatment in China is related to its clinical use by doctors rather than its market supply. Health care reforms should further improve availability and accessibility of health services. Funding: Shandong Provincial Key R&D Plan. Declaration of Interest: We declare no competing interests.