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Penicillin concentrations in serum and CSF during high-dose intravenous treatment for neurosyphilis
Abstract:
Eight neurosyphilitic patients (two asymptomatic, six symptomatic) were treated with intravenously administered aqueous penicillin G, 0.15 million IU/kg body weight/24 hrs for 15 days. On the 8th day of treatment, penicillin concentrations were determined in serum and CSF samples collected at hourly intervals over a period of 8 hours, using a microbiological assay method. Serum concentrations ranged from 0.26 to 100 mg/l, while CSF concentrations ranged from 0.062 to 3.0 mg/l. These results indicate that, by ensuring penicillin concentrations in CSF, which are continuously above the minimal fully treponemicidal concentration during the course of treatment, this treatment regimen should provide an adequate therapy for asymptomatic and symptomatic neurosyphilis.
Insights
Intravenous penicillin G effectively treats neurosyphilis. This study found penicillin concentrations in cerebrospinal fluid (CSF) remained above therapeutic levels throughout treatment for both symptomatic and asymptomatic patients.
Area of Science:
- Neurology
- Infectious Diseases
- Pharmacology
Background:
- Neurosyphilis, a late stage of syphilis infection affecting the brain, requires effective antibiotic treatment.
- Penicillin G is the recommended treatment, but optimal dosing and achievable concentrations in the central nervous system (CNS) require further understanding.
Purpose of the Study:
- To evaluate serum and cerebrospinal fluid (CSF) penicillin G concentrations in neurosyphilis patients receiving a specific intravenous dosage regimen.
- To determine if this regimen achieves sustained therapeutic levels in the CNS for effective neurosyphilis treatment.
Main Methods:
- Eight neurosyphilis patients (2 asymptomatic, 6 symptomatic) received intravenous aqueous penicillin G (0.15 million IU/kg/24 hrs) for 15 days.
- Serum and CSF samples were collected hourly for 8 hours on day 8 of treatment.
- Penicillin concentrations were measured using a microbiological assay.
Main Results:
- Serum penicillin concentrations varied widely, ranging from 0.26 to 100 mg/l.
- Cerebrospinal fluid (CSF) penicillin concentrations ranged from 0.062 to 3.0 mg/l.
- Achieved CSF penicillin levels were consistently above the minimal fully treponemicidal concentration.
Conclusions:
- The studied intravenous penicillin G regimen provides adequate therapeutic concentrations in the CSF for treating both asymptomatic and symptomatic neurosyphilis.
- Sustained CSF penicillin levels above the minimal treponemicidal concentration suggest treatment efficacy.
- This dosing strategy supports effective management of neurosyphilis.