Antibiotic therapy for adults with neurosyphilis

Area of Science:

• Neuroscience
• Infectious Diseases
• Pharmacology

Background:

• Neurosyphilis is a serious central nervous system infection caused by Treponema pallidum, a tertiary manifestation of syphilis.
• The standard first-line treatment is aqueous crystalline penicillin, but alternative antibiotic therapies are used for penicillin-allergic patients.

Purpose of the Study:

• To assess the clinical effectiveness and safety of different antibiotic therapies for treating neurosyphilis in adults.

Main Methods:

• A systematic review of randomized clinical trials comparing antibiotic regimens for neurosyphilis.
• Searched multiple databases including Cochrane Library, CENTRAL, MEDLINE, and Embase up to April 2019.
• Included trials involving adults with confirmed neurosyphilis, including those with HIV.

Main Results:

• One trial with 36 HIV-positive participants compared ceftriaxone to penicillin G.
• Results were inconclusive, with very low-quality evidence suggesting potential benefits for ceftriaxone in serological and clinical cure but insufficient data to confirm.
• The trial had significant limitations, including unclear risk of bias and lack of reporting on recurrence, recovery time, and quality of life.

Conclusions:

• Insufficient evidence exists to determine the comparative effectiveness of ceftriaxone versus penicillin G for neurosyphilis.
• The safety profile of ceftriaxone and benefits in non-HIV individuals remain unknown.
• Further high-quality, adequately powered trials adhering to CONSORT and SPIRIT guidelines are recommended, incorporating patient-centered outcomes.