Ceftriaxone as an Alternative to Penicillin for Neurosyphilis

Previous reports suggest that parenteral penicillin therapy for CNS syphilis in HIV-positive patients has a failure rate of 23% to 60%. Ceftriaxone has been proposed as an alternative therapy. To compare the efficacy of these therapies, 36 HIV-positive patients with CNS syphilis were randomized (18 in each group) over a 3.5-year period at several U.S. centers to receive 10 days of IV treatment with either 2 g of ceftriaxone dailyor 4 MU penicillin G every 4 hours. A diagnosis of CNS syphilis required a serum rapid plasma reagin of at least 1:16 (confirmed by a positive fluorescent treponemal antibody-absorbed test) and abnormal CSF findings. The patient groups appeared equal at baseline according to a variety of clinical and lab parameters,…