Penicillins neurosyphilis

As an effective treatment for neurosyphilis, the Centers for Disease Control and Prevention (CDC) endorses two regimens of penicillin. Alternatively, ceftriaxone may also be prescribed.13... 

In patients who are both negative for HIV and the lumbar puncture, administer benzathine penicillin G 2.4 million units intramuscularly once weekly for 3 additional weeks. Perform a patient follow-up in 6 months including a clinical examination and another non-treponemal titer. In HIVnegative patients with lumbar puncture findings compatible with neurosyphilis, treat the patient accordingly for neurosyphilis. 

Doxycycline6 or fluoroquinolone 0 Spirochetes Treponema pallidum Neurosyphilis Penicillin G Ceftriaxone0 Primary or secondary Benzathine penicillin G Doxycyclinee or ceftriaxone0... 

Some experts administer benzathine penicillin G 2.4 million units IM once per week for up to 3 weeks after completion of the neurosyphilis regimens to provide a total duration of therapy comparable to that used for late syphilis in the absence of neurosyphilis. For nonpregnant patients pregnant patients should be treated with penicillin after desensitization. 

Neurosyphilis - Aqueous procaine penicillin G, 2 to 4 million units/day IM plus... 

Neurosyphilis- (as an alternative to the recommended regimen of penicillin G aqueous)... 

Penicillin G Prevents bacterial cell wall synthesis by binding to and inhibiting cell wall transpeptidases Rapid bactericidal activity against susceptible bacteria Streptococcal infections, meningococcal infections, neurosyphilis IV administration rapid renal clearance (half-life 30 min, so requires frequent dosing (every 4 h) Toxicity Immediate hypersensitivity, rash, seizures... 

Spirochetes Treponema pallidum Neurosyphilis Penicillin G Ceftriaxone ... 

Patients with abnormal CSF findings should be treated as having neurosyphilis. Preferred regimens for neurosyphilis provide treatment over 10 to 14 days with parenteral penicillin G administered every 4 hours. Benzathine penicillin G alone in standard weekly doses and procaine penicillin G in doses under 2.4 million units do not consis-... 

Answer B. Indications for the use of penicillin G are currently limited for a number of reasons. The drug has a narrow spectrum, is susceptible to beta-lactamases, and may cause hypersensitivity, and alternative antibiotics are available. However, penicillin G remains the drug of choice in syphilis, usually given IM as benzathine penicillin G, but as the Na or K salt IV in neurosyphilis. What would you do for patients who are highly allergic to penicillins (Consider tetracyclines, or possibly desensitization.)... 

Therapy of syphilis with penicillin G is highly effective. Primary, secondary, and latent syphilis of <1 year s duration may be treated with penicillin G procaine (2.4 million units per day intramuscularly), plus probenecid (1.0 g/day orally) to prolong the tj for 10 days or with 1—3 weekly intramuscular doses of 2.4 million units of penicillin G benzathine (three doses in patients with HIV infection). Patients with neurosyphilis or cardiovascular syphilis typically receive intensive therapy with 20 million units of penicillin G daily for 10 days. Since there are no proven alternatives for treating syphilis in pregnant women, penicillin-allergic individuals must be acutely desensitized to prevent anaphylaxis. 

Nonpregnant, penicillin-allergic patients who have primary, secondary, or latent syphihs can be treated with a tetracychne (e.g., doxycycline, 100 mg orally twice daily for 2 weeks). Tetracyclines should not be used for neurosyphilis. 

In one patient with neurosyphilis, dementia, and a Jarisch-Herxheimer reaction after intravenous penicillin improved with olanzapine [86" ]. In another similar case a Jarisch-Herxheimer reaction was accompanied by a Hoign6 reaction after the use of high-dose intravenous penicillin [87 ]. 

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