Review of Current Evidence and Comparison of Guidelines for ...
Review of Current Evidence and Comparison of Guidelines for ...
Review of Current Evidence and Comparison of Guidelines for ...
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EUR/03/5045931<br />
page 34<br />
The period 1981–1988 was revolutionary because arsenic <strong>and</strong> bismuth preparations were<br />
cancelled. So the era <strong>of</strong> syphilis treatment by extremely harmful preparations had ended. Some<br />
other preparations were introduced, such as erythromycin, tetracycline, etc. This allowed <strong>for</strong><br />
syphilis treatment policy more flexible.<br />
In 1995 modern <strong>for</strong>eign manufactured lasting preparations, such as benzatinbenzylpenicillins,<br />
were introduced in the treatment schemes. Today 80% <strong>of</strong> the patients receive outpatient<br />
treatment. The outpatient treatment has given an opportunity to manage a large quantity <strong>of</strong><br />
diseased patients while the STI epidemic.<br />
Table 1. Basic changes in syphilis treatment policy in the <strong>for</strong>mer Soviet Union (<strong>and</strong> Russia) in 1932–2002<br />
Years The basic changes <strong>of</strong> the contents <strong>of</strong> Methodical instructions<br />
1932<br />
1945<br />
1948<br />
1951<br />
1954<br />
1962<br />
1976<br />
1981<br />
1988<br />
1993<br />
1995<br />
1999<br />
Medical preparations <strong>of</strong> heavy metals (bismuth, mercury), arsenic, iodine<br />
–<br />
Introduction in circuits <strong>of</strong> treatment <strong>of</strong> soluble penicillin<br />
–<br />
–<br />
Introduction in circuits <strong>of</strong> treatment by domestic lasting preparations <strong>of</strong> penicillin:<br />
ecmonovocillin, bicillin-1, bicillin-3.Cancellation <strong>of</strong> mercury preparations<br />
Introduction <strong>of</strong> permanent methods <strong>of</strong> treatment with lasting preparations <strong>of</strong><br />
penicillin <strong>for</strong> the separate categories, the limited introduction <strong>of</strong> outpatient treatment<br />
Arsenic preparations cancellation<br />
Bismuth preparations cancellation; course treatment cancellation. Introduction <strong>of</strong><br />
out-patient treatment <strong>of</strong> syphilis. Introduction <strong>of</strong> alternative preparations<br />
(erythromycin, doxicycline)<br />
–<br />
The circular introduction in the circuits <strong>of</strong> treatment with <strong>for</strong>eign <strong>and</strong> domestic<br />
benzatin penicillins. The beginning <strong>of</strong> transition into total outpatient treatment<br />
Increase in single dozes <strong>of</strong> soluble penicillin up to one million units, reduction <strong>of</strong><br />
duration <strong>of</strong> treatment <strong>of</strong> patients with primary <strong>and</strong> secondary syphilis by soluble<br />
penicillin. Introduction <strong>of</strong> procaine penicillin as one <strong>of</strong> the basic antibiotics <strong>and</strong><br />
ceftriaxone, as an alternative preparations<br />
By the present time in order to develop new guidelines on syphilis treatment the data <strong>of</strong> the<br />
modern <strong>for</strong>eign literature <strong>and</strong> separate scientists’ opinions without generalized analytical<br />
processing have been used. As a rule when using <strong>for</strong>eign manufactured methods the preparation<br />
doses were increased.<br />
For example: two injections <strong>of</strong> benzatinpenicillin, 2.4 million units <strong>for</strong> primary syphilis<br />
treatment, <strong>and</strong> three injections <strong>for</strong> secondary syphilis treatment (instead <strong>of</strong> one injection<br />
according to the CDC recommendation); or introduction <strong>of</strong> procaine penicillin in a dose<br />
1 200 000 units per a day within 20 days (instead <strong>of</strong> 10 days on CDC), etc.<br />
Basic contests <strong>of</strong> the Methodological <strong>Guidelines</strong> on syphilis treatment <strong>and</strong> prevention,<br />
Moscow, 1999 (2)<br />
According to this document there are the following schemes <strong>of</strong> syphilis treatment: