ISSN - 0973-0958

Pediatric Oncall Journal

How to treat congenital syphilis when aqueous penicillin is not available_?

How to treat congenital syphilis when aqueous penicillin is not available_?

Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai, India.

Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056
Clinical Problem
A 3 days old baby is diagnosed to have congenital syphilis on testing with VDRL. The child is asymptomatic and had normal birth with birth weight of 3kg. Cerebrospinal fluid {CSF} VDRL is negative. Injectable crystalline penicillin and procaine penicillin is not available.

How should this child be treated_?
Congenital syphilis, either proved or presumed, is treated with a 10-day course of aqueous penicillin G {100,000–150,000 U, kg, day, administered as 50,000 U, kg per dose, intravenously, every 12 hours during the first 7 days of life and every 8 hous thereafter for a total of 10 days} or procaine penicillin G {daily single dose of 50 000 U, kg per day, intramuscularly for 10 days}. In case of shortage of aqueous penicillin, CDC recommends that some or all daily doses should be substituted with procaine penicillin G {50,000 U, kg, dose IM a day in a single dose for 10 days}. If both aqueous or procaine penicillin G are not available, ceftriaxone may be considered with careful clinical and serologic follow-up. Ceftriaxone must be used with caution in jaundiced infants. For infants = 30 days old, it is given in dose of 75 mg, kg IV, IM, day in a single dose for 10-14 days. For older infants, this dose should be 100 mg, kg, day in a single dose. Studies that strongly support ceftriaxone for the treatment of congenital syphilis have not been done. In case of abnormal CSF examination at the beginning, a repeat CSF exam at 6 months of age if the initial exam was abnormal is recommended. {1}
In patients, if the diagnosis of congenital syphilis is not completely established, then benzathine penicillin G, 50,000 U, kg IM as a single dose can be used.
Treated infants should be followed-up at 3, 6 and 12 months of age, until serologic non-treponemal tests become non-reactive or the titre has decreased fourfold. With adequate treatment or in cases in which antibody is transplacentally acquired in the absence of congenital infection, non-treponemal antibody titres should decrease by 3 months of age and be non- reactive by 6 months of age. Previously treated infants at 6–12 months of age with increasing or persistent titres should be re-evaluated, including CSF examination, and treated with a further 10-day course of if the results are abnormal.
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None

  1. CDC. 2002 CDC Sexually Transmitted Diseases Treatment Guidelines. MMWR 2002;51 (RR-6):1-80.

Cite this article as:
Shah I. How to treat congenital syphilis when aqueous penicillin is not available?. Pediatr Oncall J. 2016;13: 81-82. doi: 10.7199/ped.oncall.2016.41
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0