Antibiotic therapy for adults with neurosyphilis

Abstract

Background Neurosyphilis is an infection of the central nervous system, caused by Treponema pallidum, a spirochete capable of infecting almost any organ or tissue in the body causing neurological complications due to the infection. This disease is a tertiary manifestation of syphilis. The first-line treatment for neurosyphilis is aqueous crystalline penicillin. However, in cases such as penicillin allergy, other regimes of antibiotic therapy can be used. Objectives To assess the clinical e ectiveness and safety of antibiotic therapy for adults with neurosyphilis. Search methods We searched the Cochrane Library, CENTRAL, MEDLINE, Embase, LILACS, World Health Organization International Clinical Trials Registry Platform and Opengrey up to April 2019. We also searched proceedings of eight congresses to a maximum of 10 years, and we contacted trial authors for additional information. Selection criteria We included randomised clinical trials that included men and women, regardless of age, with definitive diagnoses of neurosyphilis, including HIV-seropositive patients. We compared any antibiotic regime (concentration, dose, frequency, duration), compared to any other antibiotic regime for the treatment for neurosyphilis in adults. Data collection and analysis Two review authors independently selected eligible trials, extracted data, and evaluated risk of bias. We resolved disagreements by involving a third review author. For dichotomous data (serological cure, clinical cure, adverse events), we presented results as summary risk ratios (RR) with 95% confidence intervals (CI). We assessed the quality of evidence using the GRADE approach. Main results We identified one trial, with 36 participants diagnosed with syphilis and HIV. The participants were mainly men, with a median age of 34 years. This trial, funded by a pharmaceutical company, compared ce riaxone in 18 participants (2 g daily for 10 days), with penicillin G, also Antibiotic therapy for adults with neurosyphilis (Review)

The Intersection of HIV and Syphilis: Update on the Key Considerations in Testing and Management

“…Intramuscular procaine penicillin, administered with probenecid, is also a recommended alternative regimen by the CDC and European guidelines [50,51], and a recent study by Dunaway et al suggested it is equivalent to intravenous aqueous penicillin G, regardless of HIV status [95]. Ceftriaxone is a common alternative regimen that can be used in most people with penicillin allergy, but a recent Cochrane review identified minimal evidence to support its use [96]. While other drugs such as doxycycline and azithromycin have been used for syphilis therapy, and others, such as cefixime [97], are being investigated, none has been evaluated for neurosyphilis specifically, leaving us with few alternative therapeutic options.…”

An Updated Review of Recent Advances in Neurosyphilis

“…(3) Penicillin remains the first choice for the treatment of neurosyphilis, but there are few alternative treatment modalities for patients with cross-allergy of penicillin and ceftriaxone (59). Some conventional therapies also have side effects for PLWH (65).…”

Neurosyphilis: A Monkey Among Men

“… 10 Treatment for neurosyphilis is aimed at increasing and maintaining the antibiotic levels in the CNS during the period of bacterial reproduction. 4 Treatment was typically with IV penicillin G 2.4 million units for 10–14 days. 5 , 15 If patients have anaphylaxis as an allergic reaction to penicillin and desensitization is not an option, they may receive ceftriaxone 2 g daily for 10–14 days in replacement of penicillin4.…”

“…Other antibiotics with varying activity against syphilis include doxycycline 100 mg twice daily for 21–30 days or macrolides 500 mg four times daily for 30 days. 4 Although the above two substitutions still need further studies and trials to show similar efficacy as penicillin or ceftriaxone. Following treatment with penicillin or ceftriaxone clinical cure was more common than serological cure demonstrating the need for further research into other tests to gauge for objective treatment success.…”

“…Following treatment with penicillin or ceftriaxone clinical cure was more common than serological cure demonstrating the need for further research into other tests to gauge for objective treatment success. 4 …”