There are few data on the use of ceftriaxone in pregnant women diagnosed with syphilis. The aim of this study was to investigate the safety and efficacy of ceftriaxone as an alternative treatment option for syphilis during pregnancy.
Methods
A retrospective analysis of 79 pregnant women diagnosed with syphilis and treated with ceftriaxone was conducted.
Results
No cases of intolerance, Jarisch-Herxheimer reactions, or allergic reactions were recorded. The average time to seronegativation for secondary syphilis with symptoms was 6.14 months ± 2.76, and for latent forms, it was 7.52 months ± 1.84. Patients received no additional treatment. No serious adverse drug reactions were reported.
Conclusions
Data from our study support the use of ceftriaxone as an effective and safe alternative treatment for pregnant women diagnosed with syphilis when penicillin therapy is contraindicated or unavailable.
KatanamiYHashimotoTTakayaS, et al.Amoxicillin and Ceftriaxone as treatment alternatives to penicillin for maternal syphilis. Emerg Infect Dis2017; 23(5): 827–829.
ZhouPGuZXuJ, et al.A study evaluating Ceftriaxone as a treatment agent for primary and secondary syphilis in pregnancy. Sex Transm Dis2005; 32(8): 495–498.
6.
RobertsCPRaichAStafylisC, et al.Alternative treatments for syphilis during pregnancy. Sexual Trans Dis2019; 46(10): 637–640.
7.
BriggsGGFreemanRKTowersCV, et al.Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 11th ed. Philadelphia, PA: Wolters Kluwer, 2017, p. 1646.
8.
WalkerGJ. Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database Syst Rev2001; 2001(3): CD001143.
9.
KleinVRCoxSMMitchellMD, et al.The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy. Obstet Gynecol. 1990;75(3 Pt 1):375–380
10.
RacMWFRevellPAEppesCS. Syphilis during pregnancy: a preventable threat to maternal-fetal health. Am J Obstet Gynecol2017; 216(4): 352–363.
11.
HookEWRoddyREHanosfieldHH. Ceftriaxone therapy for incubating and early syphilis. J Infect Dis1988; 158(4): 881–884.
12.
HaynesAMGiacaniLMayansMV, et al.Efficacy of linezolid on treponema pallidum, the syphilis agent: a preclinical study. EBioMedicine2021; 65: 103281.
13.
RadcliffeKW. European guideline for the organization of a consultation for sexually transmitted diseases. J STD AIDS2001; 12(3_suppl): 14–26.
14.
SchöferHVogtHJMilbradtR. Ceftriaxone for the treatment of primary and secondary syphilis. Chemotherapy1989; 35(2): 140–145.
15.
Ceftriaxone SmPC. EMA. European Medicines Agency. European medicines agency. Available from: https://www.ema.europa.eu/en
16.
StammLV. Hope for new antibiotics for syphilis treatment. EBioMedicine2021; 66: 103320.
17.
FrenchPGombergMJanierM, et al.2008 European guidelines on the management of syphilis. Int J STD AIDS. 2009;20(5):300–309.
18.
LiangZChenYPYangCS, et al.Meta-analysis of Ceftriaxone compared with penicillin for the treatment of syphilis. Int J Antimicrob Agents2016; 47(1): 6–11.
19.
PatelIHKaplanSA. Pharmacokinetic profile of Ceftriaxone in man. Am J Med1984; 77(4C): 17–25.
20.
TaylorMMKaraEOAraujoMAL, et al.Phase II trial evaluating the clinical efficacy of cefixime for treatment of active syphilis in non-pregnant women in Brazil (CeBra). BMC Infect Dis2020; 20(1): 405.
21.
PhamMNHoHenDesaiM. Penicillin desensitization: Treatment of syphilis in pregnancy in penicillin-allergic patients. Ann Allergy Asthma Immunol2017; 118(5): 537–541.
22.
MckenzieK, Olges J. Jarisch-Herxheimer reaction after Cephalosporin administration in syphilis. Cureus2021; 13(1): e12750
23.
HartmaneIMikazansIBrantaD, et al.Treatment and prevention of syphilis. Riga: Nacionalais apgads, 2004.
24.
HeikkinenTLaineKNeuvonenPJ, et al.The transplacental transfer of the macrolide antibiotics erythromycin, roxithromycin and azithromycin. BJOG2000; 107(6): 770–775.
World Health Organization. WHO guideline on syphilis screening and treatment for pregnant women. Geneva: World Health Organization; 2017. Available from: https://apps.who.int/iris/handle/10665/259003
