From the Guidelines
Otosyphilis treatment should be the same as neurosyphilis treatment, which typically involves aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units IV every 4 hours or continuous infusion, for 10-14 days.
Treatment Options
- The recommended regimen is aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units IV every 4 hours or continuous infusion, for 10-14 days 1.
- An alternative regimen is procaine penicillin 2.4 million units IM once daily, plus probenecid 500 mg orally four times a day, both for 10-14 days 1.
- Some specialists may also administer benzathine penicillin, 2.4 million units IM once per week for up to 3 weeks after completion of these neurosyphilis treatment regimens to provide a comparable total duration of therapy 1.
Important Considerations
- All patients with syphilis should be tested for HIV 1.
- Systemic steroids are not proven beneficial as adjunctive therapy for otologic syphilis 1.
- Ceftriaxone can be used as an alternative treatment for patients with neurosyphilis, although the possibility of cross-reactivity between this agent and penicillin exists 1.
- Penicillin G, administered parenterally, is the preferred drug for treatment of all stages of syphilis 1.
From the Research
Treatment Overview
The treatment for otosyphilis typically involves the use of antibiotics, specifically penicillin, and in some cases, corticosteroids.
- Penicillin is the primary treatment for otosyphilis, with studies showing improvement in hearing, tinnitus, and vertigo in some patients 2, 3, 4, 5, 6.
- The use of corticosteroids as an adjuvant therapy has been reported in some studies, with varying degrees of success 2, 5, 6.
Treatment Regimens
Different treatment regimens have been used to treat otosyphilis, including:
- Intravenous penicillin G sodium (PGS) at a dose of 24 mu/day for 14 days 3.
- A combined course of long-term penicillin and prednisone 5.
- Penicillin G plus additional medications, such as benzathine penicillin and probenecid 3.
Response to Treatment
The response to treatment for otosyphilis can vary, with some studies reporting: