Intravenous benzylpenicillin is the standard treatment for neurosyphilis, but it requires prolonged hospitalization. Ceftriaxone is a possible therapeutic alternative, the effectiveness of which remains uncertain. We aimed to assess the efficacy of ceftriaxone compared to benzylpenicillin in the treatment of neurosyphilis.
We conducted a retrospective multicenter study including patients with neurosyphilis who were treated in one of the eight tertiary care centers in France, from January 1, 1997 to December 31, 2017. We defined neurosyphilis as treponemal tests and not treponemal positive and at least one of otic syphilis, ocular syphilis, either a neurological symptom with a positive result on the cerebrospinal fluid (CSF) -VDRL or CSF-PCR tests, or more than five leukocytes in a cell count of the LCR. Patients with neurosyphilis were identified from the database of the medical information service of each center and assigned to one of two groups based on the initial treatment received (i.e. Benzylpenicillin group or ceftriaxone group). The primary outcome measure was the overall clinical response (i.e. the proportion of patients with a complete or partial response) 1 month after the start of treatment. The secondary endpoints were the proportions of patients with a complete response at 1 month and a serological response at 6 months, and the duration of hospitalization.
Out of 365 patients with a coded diagnosis of neurosyphilis in one of the eight health centers between 1997 and 2017, 208 were included in this study (42 in the ceftriaxone group and 166 in the benzylpenicillin group). The mean age of the patients was 44.4 years (SD 13.4) and 193 (93%) were males. We observed 41 cases of overall clinical response (98%) in the ceftriaxone group versus 125 (76%) in the benzylpenicillin group (crude odds ratio [OR] 13 · 02 [95% CI 1·73–97·66], p = 0.017). After weighting for the propensity score, the overall clinical response rates remained different between the groups (OR 1 22 [95%
CI 1·12–1·33], p vs 76 [82%] 93 in the benzylpenicillin group; gross OR 1 56 [95% CI 0·42–5·86], p = 0.50), while hospitalization was shorter for patients in the ceftriaxone group than for those in the benzylpenicillin group (mean of 13.8 days [95% CI 12·8–14·8] vs 8 9 days [5·7–12·0], p Interpretation
Our results suggest that ceftriaxone is just as effective as benzylpenicillin for the treatment of neurosyphilis, potentially reducing the length of hospital stay. Randomized controlled trials should be performed to confirm these results.