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.
A standard protocol was developed to retest and retreat all patients and contacts who had been treated with Bicillin C-R for syphilis.
One patient treated for syphilis with Bicillin C-R subsequently had neurosyphilis diagnosed.
The company is changing the packaging and syringe labels of Bicillin C-R
to highlight the distinction between that product and Bicillin L-A.
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.
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.
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.
In county B, 10 syphilis patients received Bicillin C-R during an 11-day period according to the clinic's syphilis treatment records.
To determine the frequency of Bicillin C-R use in STD clinics nationwide and to educate STD program managers about the possible confusion between Bicillin C-R and Bicillin L-A, CDC surveyed 65 STD program areas during January-February 1999 about unintentional Bicillin C-R use from 1993 through 1998.
The notional amounts for the class C-R, D-R and E-R notes remain the same as their previously outstanding class balances.
--Class C-R notes spread reduced to 1.85% from 3.20% on class C notes;