Alternative Treatments for Syphilis During Pregnancy

Roberts, Chelsea; Raich, Aishwarya; Stafylis, Chrysovalantis; Klausner, Jeffrey D.

doi:10.1097/olq.0000000000001050

Cited by 17 publications

(25 citation statements)

References 23 publications

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“…Sufficient evidence is not available to recommend an alternative regimen. In a systematic review on alternative treatments for pregnant women with syphilis, only 21 pregnant women treated with regimens other than BPG could be identified (6). Erythromycin and azithromycin do not cross the placental barrier and thus cannot treat infections in the fetus (6).…”

Section: Researchmentioning

confidence: 99%

“…In a systematic review on alternative treatments for pregnant women with syphilis, only 21 pregnant women treated with regimens other than BPG could be identified (6). Erythromycin and azithromycin do not cross the placental barrier and thus cannot treat infections in the fetus (6). Macrolide-resistant T. pallidum has been reported in many countries (7).…”

Section: Researchmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness and Tolerability of Oral Amoxicillin in Pregnant Women with Active Syphilis, Japan, 2010–2018

Nishijima¹,

Kawana²,

Fukasawa³

et al. 2020

Emerg. Infect. Dis.

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Section: Researchmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

Effectiveness and Tolerability of Oral Amoxicillin in Pregnant Women with Active Syphilis, Japan, 2010–2018

Nishijima¹,

Kawana²,

Fukasawa³

et al. 2020

Emerg. Infect. Dis.

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“…Doxycycline and tetracycline are available alternative treatments for non-pregnant patients who are allergic to penicillin [5][6][7][8]. Injectable daily ceftriaxone is another alternative treatment that may be considered and is safe in pregnancy, as a recent review from our team showed [9].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Clinical trial protocol to evaluate the efficacy of cefixime in the treatment of early syphilis

Mehta

Stafylis

Tellalian

et al. 2020

Trials

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Background Syphilis rates have been increasing both in the USA and internationally with incidence higher among men-who-have-sex-with-men and people living with human immunodeficiency virus (HIV) infection. Currently, benzathine penicillin is the recommended treatment for syphilis in all patients. Global shortages and cost increases in benzathine penicillin call for alternative treatment options. This study evaluates the efficacy of oral cefixime for the treatment of early syphilis. Methods We are conducting a randomized, multisite, open-label, non-comparative clinical trial in Los Angeles and Oakland, CA. Eligible participants are ≥ 18 years old, with primary, secondary, or early latent syphilis (rapid plasma reagin [RPR] titer ≥ 1:8). Patients with HIV infection must have a viral load ≤ 200 copies/mL and CD4+ T cell count ≥ 350 cells/μL during the past 6 months. Participants are randomized to receive either 2.4 M IU benzathine penicillin G intramuscularly once or cefixime 400 mg orally twice a day for 10 days. Participants return at 3, 6, and 12 months post-treatment for follow-up RPR serological testing. The primary outcome is the proportion of participants who achieve ≥ 4-fold RPR titer decrease at 3 or 6 months post-treatment. Discussion Clinical trials evaluating the efficacy of alternative antibiotics to penicillin are urgently needed. Trial registration Clinicaltrials.gov NCT03660488. Registered on 4 September 2018.

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“…Doxycycline and tetracycline are available alternative treatments for nonpregnant patients who are allergic to penicillin (5)(6)(7)(8). Injectable daily ceftriaxone is another alternative treatment that may be considered and is safe in pregnancy, as a recent review from our team showed (9).…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Clinical Trial Protocol to Evaluate the Efficacy of Cefixime in the Treatment of Early Syphilis

Mehta

Stafylis

Tellalian

et al. 2020

Preprint

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Background: Syphilis rates have been increasing both in the US and internationally with incidence higher among men-who-have-sex-with-men and people living with human immunodeficiency virus (HIV) infection. Currently, benzathine penicillin is the recommended treatment for syphilis in all patients. Global shortages and cost increases in benzathine penicillin call for alternative treatment options. This study evaluates the efficacy of oral cefixime for the treatment of early syphilis. Methods: We are conducting a randomized, multisite, open-label, non-comparative clinical trial in Los Angeles and Oakland, California. Eligible participants are ≥18 years old, with primary, secondary or early latent syphilis (Rapid Plasma Reagin [RPR] titer ≥1:8). Patients with HIV infection must have a viral load ≤200 copies/mL and CD4+ T cell count ≥350 cells/μl during the past 6 months. Participants are randomized to receive either 2.4M IU benzathine penicillin G intramuscularly once or cefixime 400mg orally twice a day for 10 days. Participants return at 3, 6, and 12 months post-treatment for follow-up RPR serological testing. The primary outcome is the proportion of participants who achieve ≥4-fold RPR titer decrease at 3- or 6-months post-treatment.Discussion: Clinical trials evaluating the efficacy of alternative antibiotics to penicillin are urgently needed. Trial Registration: Clinicaltrials.gov, NCT03660488. Registered September 4, 2018, https://clinicaltrials.gov/ct2/show/NCT03660488

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Alternative Treatments for Syphilis During Pregnancy

Cited by 17 publications

References 23 publications

Effectiveness and Tolerability of Oral Amoxicillin in Pregnant Women with Active Syphilis, Japan, 2010–2018

Effectiveness and Tolerability of Oral Amoxicillin in Pregnant Women with Active Syphilis, Japan, 2010–2018

Clinical trial protocol to evaluate the efficacy of cefixime in the treatment of early syphilis

Clinical Trial Protocol to Evaluate the Efficacy of Cefixime in the Treatment of Early Syphilis

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