Review of Current Evidence and Comparison of Guidelines for ...

EUR/03/5045931
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is that instead of one course two treatment courses are prescribed, and spinal fluid control should
be done after six months.
In case if SF sanitation is absent then one more treatment course should be done.
Prednisolone usage in the beginning of therapy is prescribed to patients with progressive
paralysis who may get the aggravation of psychotic symptoms on the treatment background.
Special attention is paid to the treatment methods concerning cerebrum or spinal cord gummas.
This pathology needs prednisolone application together with penicillin therapy which should be
done within the first course of treatment (two weeks); it improves treatment’s efficacy.
Prednisolone treatment may also precede penicillin therapy for few days, what promotes
recourse of clinical symptoms of disease.
Duly revealing and adequate treatment of cerebrum and spinal cord gummas may bring complete
recovery (SF control and МРТ are necessary). A progressive paralysis and tabes dorsalis are
most resistant against treatment. As a rule, the best treatment result is the cessation of disease’s
progress.
9. Alternative (reserve) methods of syphilis treatment
In case of penicilline intolerance so-called reserve preparations are to be used. Doxycycline is a
preferable one. It is applied per os in a dose 0.1 twice a day.
Preventive treatment duration is 10 days, primary syphilis treatment duration is 15 days,
secondary and early latent syphilis treatment duration is 30 days.
Tetracycline is applied in a daily doze 2.0 (on 0.5 х 4 times a day). It is necessary to pay
attention to observance of equal intervals between receptions of a preparation (six hours).
Duration of treatment is the same, as in the application of doxycycline.
While taking doxycycline and as well as tetracycline therapy during summertime patients should
restrain from long irradiation under direct sun in order to avoid photosensitizing collateral action.
Children under eight are not recommended to take tetracycline preparations as they interact with
bone tissue.
Pregnant women being not able to take tetracycline preparations should take erythromycin in the
same daily and single doses and with the same duration of rates as tetracycline. As erythromycin
doesn’t penetrate through placenta so the child should be treated with penicillin after his birth.
Besides semisynthetic penicillins, oxacillin, and ampicillin can be applied. They are injected
intramuscularly in a dose 1 million units per injection (one dose is dissolved in 5–6 ml of
distilled water) 4 times a day. The duration of the preventive treatment is 10 days, the primary
syphilis treatment duration is 14 days, the secondary and early latent syphilis treatment duration
is 28 days.
Among the preparations of the cefalosporin line ceftriaxone – cefalosporin of the third
generation is recommended. It penetrates into organs, tissues and liquids nicely, especially into
spinal fluid . It has a high antitreponemal activity. It is significant to consider that the experience