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With syphilis spreading in Canada at rates unseen in decades, doctors are struggling to cope with a shortage of the main drug used to treat the potentially deadly infection.

The Public Health Agencyof Canada took the rare step recently of posting guidelines on how to ration Bicillin, and what alternative medications might be appropriate in some cases.

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It’s the latest in a string of pharmaceutical supply crises to bedevil the health-care system in recent years, as government and industry hunt for solutions.

A national database lists more than 800 drugs in shortage, the date they might return to normal supply often unknown.

It is very, very concerning to us to have supply of this drug run out, because we are in a period of resurgence of syphilis in many parts of Canada

More worrisome is that every year sees a few “tier-three” shortages, where the lack of a drug actually affects people’s health, said Dr. Supriya Sharma, a Health Canada senior medical advisor.

The Bicillin case – caused by manufacturing problems at Canada’s sole supplier, a Pfizer plant in the United States – is one of those.