R

No porwaiun

Ponollr

Retef to appfopnato subspeciaiist Benzathne penollm G. 2.4 m*on units im once woeWy tor 3 wee Ks (3 oosesj*

Deo sensitization

Aqueous crystalline penofcn G. 3-4 rrakon units IV every 4 hours lor 10-14 days or procamo penicillin G. 2.4 mfcon units IM darfy. plus 500 mg ot probonood oraBy tour times dady br 10-14 days

FIGURE 80-1. Treatment of syphilis. (CSF, cerebrospinal fluid; IM, intramuscularly.) (From Brown D, Frank J. Diagnosis and Management of Syphilis. Am Fam Physician. 2003;68(2):283-290.) a Alternative treatments for nonpregnant penicillin-allergic patients: doxycycline 100 mg orally twice daily for 2 weeks, or tetracycline 500 mg four times daily for 2 weeks; limited data support ceftriaxone 1 g once daily IM or IV for 8 to 10 days; or azithromycin, 2 g orally (single dose). Alternative treatments for nonpregnant penicillin-allergic patients: doxycycline, 100 mg orally twice daily for 4 weeks, or tetracycline 500 mg orally four times daily for 4 weeks.

Table 80-1 Benzathine and Procaine Penicillin G Informational Chart

Categorlei

Benzathine Penicillin

Pf(Kline Penicillin G

Poitnilil 4dnef it leaelloni

Pret| nancy calegay

Lradon

AvMUbMy

COmbirUfljün

í. NS: iQfmlt«0f n. íortf uí¡ú4X diomlrwü, mytxkxujs. fe-wefiOeinriäiiciogic- IJÜT; meiiboK-elec I lolytp imbalance, Hemaiotogic: positive Coofnbfc IWI, iictnotytfc aiwfliit total pain,

íniOmtiOpMífcifirj: nfn^ sctue inu^^EicL^l nephriL^. mkcelldiieoui. anaphylaxis. liyiMriirtiitivilv. la&dtHtfthcinMf NHClíflíi

Otewvt ít» aiuciiviinri duiüig doit

Einers bfftaiT milk

Pi. :ln L ft WOXXWdi^yimL ft 2, and 4 inU PeimafK?n kojott: 60(3(030 unlti/ml (2 mL]

CNi seiii*«, COfillStOrt, dMünfi^ royOttarmi. CNS AMiHHlcn

(!rUtioi-d iL ni,si myocjrdul depression. vasodilation, condudtondktu bof*« Hemalote^k: positive CocmtK tesi, hemolytic memioi ■■eulropfpiid lOCit ifKomljCphletarii;. vieitV absf ar ¡ration <Jhe Renal. tmersTilial rpphnlis MtHBlllWOlJSi |JKÍUd(Mnd(ilTyldU¡c rpjcliOli, hyp«5ensJ<lvtt\t Jailsrh-Hershelmer reactkin, wrum sickness

Perkxk rwvii ortd hemaKilogfc rundirn mis with pínkjníjed iherapy; fever, memal íttfiii!, Wßt

l.nldl DiL'iftC rnilk inj<MilOft.tuí|K*(ílOry 609,000 urfti/ml (!.2 WL) Sanr*

CMS, central nervousjyiii^ IM, intramuscular. Fiom ft?f. it-

Gummatous and Cardiovascular Syphilis

As long as no evidence of CNS involvement exists, antibiotic therapy for gummatous and cardiovascular syphilis is identical to that for tertiary syphilis.

Neurosyphilis

As an effective treatment for neurosyphilis, the Centers for Disease Control and Prevention (CDC) endorses two regimens of penicillin. Alternatively, ceftriaxone may also be prescribed.18

The regimens of choice are aqueous penicillin G 3 to 4 million units administered IV every 4 hours for 10 to 14 days OR procaine penicillin G 2.4 million units admin istered intramuscularly once daily, plus probenecid 500 mg orally four times daily, both for 10 to 14 days.

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