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Serologic response to VDRL in infants with congenital syphilis: ceftriaxone vs. penicillin

Ana Nery Melo Cavalcante1, Maria Alix Leite Araújo2, Beatriz Sobreira Camilo Soares3

  • 1Universidade de Fortaleza, Fortaleza, CE, Brazil; Sociedade Brazileira de Pediatria (SBP), Fortaleza, CE, Brazil.

Jornal De Pediatria
|March 16, 2026
PubMed

Insights

Ceftriaxone offers a comparable serological response to penicillin for treating congenital syphilis (CS) in infants. This finding is crucial when penicillin allergy or unavailability necessitates alternative therapies for CS.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Pharmacology

Background:

  • Penicillin is the primary treatment for congenital syphilis (CS) in pregnant women and infants.
  • Alternative therapies are essential due to penicillin allergies or supply shortages.
  • Evaluating ceftriaxone as a penicillin alternative for CS is critical.

Purpose of the Study:

  • To compare the serological response to the Venereal Disease Research Laboratory (VDRL) test in infants with CS treated with ceftriaxone versus penicillin.
  • To assess the efficacy of ceftriaxone as an alternative treatment for congenital syphilis.

Main Methods:

  • A cohort study analyzed data from 383 infants with CS in Fortaleza, Brazil.
  • Serological response was assessed via VDRL testing, with adequate response defined as two consecutive negative tests.
  • Kaplan-Meier survival analysis compared time to VDRL negativity between ceftriaxone and penicillin groups.

Main Results:

  • Fifty-six infants (14.6%) met study criteria, with 19 receiving ceftriaxone and 37 receiving penicillin.
  • No statistically significant difference in the time to VDRL negativity was observed between the treatment groups (p=0.73).
  • The median time to VDRL negativity was 3 months for both ceftriaxone and penicillin cohorts.

Conclusions:

  • Serological response to VDRL was comparable between infants treated with ceftriaxone and penicillin for congenital syphilis.
  • Ceftriaxone demonstrated similar efficacy to penicillin in achieving serological cure.
  • No kernicterus or CS-related complications were reported in infants treated with ceftriaxone.
Abstract

Keywords:
CeftriaxoneCongenital syphilisInfectious diseasesPenicillinVDRL

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