Penicillin and Ceftriaxone for Early Syphilis

Summary

A randomized, open-label controlled study 2 evaluating the efficacy of ceftriaxone and benzathine penicillin G for early syphilis was conducted in 4 hospitals in Jiangsu Province. 230 subjects completed the follow-ups. Treatment comprised either ceftriaxone (1.0 g, i.v., once daily for 10 days) or benzathine penicillin (2.4 million units, i.m., once weekly for 2 weeks). A serological response was defined as a ≥4-fold decline in the rapid plasma reagin (RPR) titer. The serological response at 6 months of follow-up was observed in 90.2% in ceftriaxone group and 78.0% in benzathine penicillin group (P = .01). There was no significant difference between treatment groups in patients with primary or early latent syphilis, but among patients with secondary syphilis the difference was highly significant (95.8% vs 76.2%; P < .01). Moreover, patients exhibiting a Jarisch-Herxheimer reaction after treatment might have a shorter period before a serological response (P = .03).

A network meta-analysis 1 included 3 RCTs and 7 cohort studies assessing treatments with penicillin, doxycycline/tetracycline, and ceftriaxone for early syphilis. Used treatments were benzathine penicillin 2.4 MU. i.m. or 3 x 2,4 MU i.m or different doses procain penicillin, ceftriaxone 1 or 2 g i.m./i.v. for 14 to 21 days, or doxycycline 100mg twice a day for 14 days (tetracycline 500 mg orally, 4 times a day for 14 days). No significant differences existed in serological response rate at 12-month follow-up between any two of the 3 treatments (doxycycline/tetracycline vs. penicillin RR 1.01, 95%CI 0.89 to 1.14; ceftriaxone vs. penicillin RR 1.00, 95%CI 0.89 to 1.13; ceftriaxone vs. doxycycline/tetracycline RR 0.99, 95%CI 0.96 to 1.03), which was consistent with the outcomes of the direct meta-analysis. In addition, the direct meta-analysis indicated that, at 12-month follow-up, penicillin and ceftriaxone treatment groups had similar treatment failure rates (RR 0.92, 95%CI 0.12 to 6.93), while treatment failure rate was significantly lower among penicillin recipients than among doxycycline/tetracycline recipients (RR 0.58, 95% CI 0.38 to 0.89).

A meta-analysis 3 of ceftriaxone comparing with penicillin included 7 RCTs involving 281 participants (159 patients with ceftriaxone and 122 patients with penicillin). There were no significant differences in 3-month response rate (RR 1.12, 95% CI 0.89 to 1.42), 6-month response rate (RR 1.02, 95% CI 0.75 to 1.38), 12-month response rate (RR 1.04, 95% CI 0.82 to 1.32), relapse rate (RR 0.91, 95% CI 0.45 to 1.84), serofast rate (RR 0.69, 95% CI 0.22 to 2.12) or failure rate (RR 0.66, 95% CI 0.03 to 15.76) in patients treated with ceftriaxone compared with those treated with penicillin.