pediatrics
Congenital Syphilis
Treatment of Congenital Syphilis
Parenteral penicillin (2.4 million units IM in a single dose). For later stages of syphilis or neurosyphilis, the appropriate regimen for nonpregnant patients should be followed ( see Late latent or tertiary syphilis ). Occasionally, a severe Jarisch-Herxheimer reaction occurs after such therapy, leading to spontaneous abortion. Patients allergic to penicillin may be desensitized and then treated with penicillin. After adequate treatment, RPR and VDRL test results decrease 4-fold by 6 to 12 months in most patients and revert to negative by 2 years in nearly all patients.Erythromycintherapy is inadequate for both the mother and fetus and is not recommended.Tetracyclineis contraindicated. 50,000 units/kg IM once/day for 10 days ( see Table: Recommended Dosages of Selected Parenteral Antibiotics for Neonates ). If ≥ 1 day of therapy is missed, the entire course must be repeated. This regimen is also recommended for infants with possible syphilis if the mother fits any of the following criteria: Untreated Treatment status unknown Treated≤4 weeks before delivery Inadequately treated (a nonpenicillin regimen) Maternal evidence of relapse or reinfection (≥ 4-fold increase in maternal titer) In infants with possible syphilis whose mothers were not adequately treated but who are clinically well and have a completely negative full evaluation, a single dose of benzathine penicillin 50,000 units/kg IM is an alternative treatment choice in selected circumstances but only if follow-up is ensured. Infants with possible syphilis whose mothers were adequately treated and who are clinically well also can be given a single dose of benzathine penicillin 50,000 units/kg IM. Alternatively, if close follow-up is ensured, some clinicians defer penicillin and do nontreponemal serologic testing monthly for 3 months and then at 6 months; antibiotics are given if titers rise or are positive at 6 months. CSF should be examined before treatment starts. The CDC recommends that any child with late congenital syphilis be treated with aqueous crystallinepenicillin G50,000 units/kg IV every 4 to 6 hours for 10 days. A single dose of benzathinepenicillin G50,000 units/kg IM may also be given at the completion of the IV therapy. Alternatively, if a full evaluation is completely negative and the child is asymptomatic, benzathinepenicillin G50,000 units/kg IM once a week for 3 doses may be used. Many patients do not revert to seronegativity but do have a 4-fold decrease in titer of reagin (eg, VDRL) antibody. Patients should be reevaluated at regular intervals to ensure the appropriate serologic response to therapy has occurred and that there is no indication of relapse. Interstitial keratitis is usually treated with corticosteroid andatropinedrops in consultation with an ophthalmologist. Patients with sensorineural hearing loss may benefit from penicillin plus a corticosteroid such asprednisone0.5 mg/kg orally once/day for 1 week, followed by 0.3 mg/kg once/day for 4 weeks, after which the dose is gradually reduced over 2 to 3 months. Corticosteroids have not been critically evaluated in these conditions. 