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Patient Management/Treatment
Treatment Regimens
The following are 2006 CDC-recommended treatment regimens for syphilis. Refer to the 2006 CDC STD Treatment Guidelines for additional and more detailed information.
Penicillin G, administered parenterally, is the preferred
drug for treatment of all stages of syphilis. The
preparation(s) used (i.e., benzathine, aqueous procaine, or
aqueous crystalline), the dosage, and the length of
treatment depend on the stage and clinical manifestations of
the disease. However, neither combinations of benzathine
penicillin and procaine penicillin nor oral penicillin
preparations are considered appropriate for the treatment of
syphilis. Reports have indicated that inappropriate use of
combination benzathine-procaine penicillin (Bicillin C-R®)
instead of the standard benzathine penicillin product widely
used in the United States (Bicillin L-A®) has occurred.
Practitioners, pharmacists, and purchasing agents should be
aware of the similar names of these two products and avoid
use of the inappropriate combination therapy agent for
treating syphilis.
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Adults
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Primary, secondary, and early latent syphilis without neurologic involvement:
Benzathine penicillin G, IM, 2.4 million units in a single dose
If penicillin allergic (one of the following):
Doxycycline 100 mg orally twice daily for 2 weeks
Tetracycline 500 mg orally 4 times daily for 2 weeks
Late latent or latent syphilis of unknown duration without neurologic involvement:
Benzathine penicillin G 7.2 million units total, administered as three doses of 2.4 million units IM each at 1-week intervals
If penicillin allergic (one of the following):
Doxycycline 100 mg orally twice daily for 28 days
Tetracycline 500 mg orally 4 times daily for 28 days
Tertiary (late) syphilis without neurologic involvement:
Benzathine penicillin G 7.2 million units total, administered as three doses of 2.4 million units IM each at 1-week intervals
If penicillin allergic:
Treat according to treatment for late latent syphilis.
Neurosyphilis:
Aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units IV every 4 hours or continuous infusion for 10-14 days IV
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Alternative regimen (if compliance can be ensured):
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Procaine penicillin 2.4 million units IM once daily
PLUS
Probenecid 500 mg orally 4 times a day, both for 10-14 days
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