From the Guidelines
The recommended duration of treatment for congenital syphilis is 10 days of parenteral penicillin G. Specifically, aqueous crystalline penicillin G at a dose of 200,000–300,000 units/kg/day IV, administered as 50,000 units/kg every 4–6 hours for 10 days, is the preferred regimen, as recommended by the most recent guidelines 1. Alternatively, procaine penicillin G at 50,000 units/kg/dose IM once daily for 10 days can be used. If more than one day of therapy is missed, the entire course should be restarted. This extended treatment duration is necessary because the spirochete Treponema pallidum, which causes syphilis, has a slow replication time, and adequate drug levels must be maintained to effectively eliminate the infection. Penicillin remains the only proven effective antimicrobial for treating neurosyphilis and congenital syphilis. For infants with confirmed or highly suspected congenital syphilis, treatment should begin immediately after diagnosis, even before confirmatory test results are available, to prevent long-term complications including bone deformities, neurological problems, and developmental delays.
Some key points to consider in the treatment of congenital syphilis include:
- The use of treponemal tests to evaluate treatment response is not recommended, as the results can remain positive despite effective therapy 1.
- Infants whose initial CSF evaluations are abnormal should undergo a repeat lumbar puncture approximately every 6 months until the results are normal 1.
- A reactive CSF VDRL test or abnormal CSF indices that cannot be attributed to other ongoing illness requires retreatment for possible neurosyphilis 1.
- Follow-up of children treated for congenital syphilis after the newborn period should be conducted as recommended for neonates 1.
It is essential to note that the treatment guidelines for congenital syphilis have been updated over time, with the most recent recommendations provided in the 2010 guidelines 1. These guidelines emphasize the importance of prompt and effective treatment to prevent long-term complications and improve outcomes for affected infants.
From the FDA Drug Label
Syphilis (congenital and neurosyphilis) after the newborn period 200,000 to 300,000 units/kg/day (administered as 50,000 units/kg every 4 to 6 hours) for 10 to 14 days The recommended duration of treatment for congenital syphilis is 10 to 14 days 2.
From the Research
Duration of Treatment for Congenital Syphilis
The recommended duration of treatment for congenital syphilis is typically 10 days of intravenous aqueous crystalline penicillin G 3. This is the current therapeutic standard of care.
Alternative Treatment Options
Alternative treatment options are being explored due to the limitations of the current standard treatment, including the need for hospitalization and the potential for treatment failure. These alternatives include:
- Ceftriaxone as a potential parenteral candidate 3
- Amoxicillin as a potential oral candidate 3
- Other therapeutic alternatives such as cefotaxime, ampicillin, doxycycline, cefixime, and linezolid 3
Comparison of Treatment Regimens
Studies have compared the efficacy of different treatment regimens for congenital syphilis. One study found that treatment with either benzathine penicillin G or procaine penicillin G for 10 days was effective, with no significant differences in outcome between the two groups 4. Another study found that aqueous penicillin G resulted in higher cerebrospinal fluid penicillin levels compared to procaine penicillin G 5.
Importance of Prompt Treatment
Prompt treatment of congenital syphilis is necessary to avoid devastating consequences, particularly in cases with skeletal presentation 6. Penicillin treatment can reverse most changes associated with congenital syphilis.