Syphilis%20-%20primary Treatment

Treatment

Principles of Therapy

A treponemocidal level of antimicrobials needs to be achieved in the serum to provide effective treatment for primary syphilis
Follow recommendations for treatment of late syphilis if the stage of syphilis is unknown
Duration of treponemocidal level of antibiotic should be at least 7-10 days

Pharmacotherapy

Antibiotic Therapy

Penicillin

Eg Benzathine, aqueous procaine, aqueous crystalline penicillin, Amoxicillin
Preferred drug for the treatment of all stages of syphilis
- Parenteral penicillin G is the only therapy with documented efficacy for syphilis during pregnancy
Adequate penicillin therapy ends infectivity within 24-48 hours
Parenteral route is preferred because it provides guaranteed bioavailability and supervised treatment
- Oral penicillin preparations are not appropriate for the treatment of syphilis
Replacing half of the solvent by Lidocaine 1% solution may reduce injection-associated pain
Efficacy of penicillin is well established based on clinical experience, case series and clinical trials

Alternatives to Penicillin

May be used for the treatment of primary syphilis in patients who are non-pregnant, penicillin-allergic and inpatients who refuse parenteral treatment
Data to support the use of alternatives to penicillin in the treatment of early syphilis are limited; hence, patient streated with alternative agents to penicillin should be followed closely because efficacy of these regimens is not well documented

Tetracycline Derivatives

Eg Doxycycline, Tetracycline
Doxycycline can be given as an alternative to Penicillin in both early and late syphilis
- Avoid Doxycycline in pregnant women

Cephalosporin

Ceftriaxone
- Penetrates blood-brain barrier well

Macrolides

May be considered if there is no other suitable treatment option and close follow-up can be done
Azithromycin
- Intrinsically resistant T pallidum strains have been detected
- Also effective against C trachomatis, N gonorrhoeae and H ducreyi
Erythromycin
- Least effective and does not penetrate blood-brain and placental barrier

Kids hard-hit by Delta; which ART performs best?

Elvira Manzano, 24 Oct 2021

That COVID-19 mostly spared children might be changing. The Delta variant has taken a severe, unthinkable toll on kids – at least in Arkansas, US, reports an expert at IDWeek 2021.

Antigen rapid tests: Moving toward more efficient COVID-19 testing

Dr. Leong Hoe Nam, 01 Jul 2021

At the time of writing, there have been 175,306,598 confirmed infections and 3,792,777 deaths attributed to the COVID-19 pandemic globally. [https://covid19.who.int/, accessed 14 June 2021] Real-time reverse transcription polymerase chain reaction (RT-PCR) has been instrumental in detecting the infection and preventing more widespread transmission of the disease.

Tackling multidrug-resistant gram-negative bacterial infections in critically ill patients: Challenging the standard approach

Dr. Asok Kurup, Dr. Kenneth Chan, 07 Dec 2020

The rising incidence of infections caused by multidrug-resistant (MDR) gram-negative bacteria has become a serious health threat and a major challenge for intensivists. Against a backdrop of high patient mortality and risk factors for infection in intensive care units (ICU), early adequate therapy is of paramount importance. At a recent Pfizer-sponsored symposium, Dr Asok Kurup, Infectious Disease Physician, Singapore presented the implications of MDR gram-negative infections in critically ill patients in Asia, while Dr Kenneth Chan, Respiratory Physician and Intensivist, Singapore highlighted the role of ceftazidime-avibactam (Zavicefta) and shared published real-world data on ceftazidime-avibactam.