Antibiotics for syphilis diagnosed during pregnancy

Cochrane Review by Walker GJA

This record should be cited as: Walker GJA. Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD001143. DOI: 10.1002/14651858.CD001143.

ABSTRACT

Title

Antibiotics for syphilis diagnosed during pregnancy

Background

Congenital syphilis is an increasing problem in many developing countries and in the transitional economies of Eastern Europe and the former Soviet Union. In several countries this increase has been aggravated by HIV/AIDS. While the effectiveness of penicillin in the treatment of syphilis in pregnant women and the prevention of congenital syphilis was established shortly after the introduction of penicillin in the 1940s, there is uncertainty about the optimal treatment regimens.

Objectives

To identify the most effective antibiotic treatment regimen (in terms of dose, length of course and mode of administration) of syphilis with and without concomitant infection with HIV for pregnant women infected with syphilis.

Search strategy

The Cochrane Pregnancy and Childbirth Group Trials Register (March 2006), the Cochrane Infectious Diseases Group Trials Register (March 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to March 2006), EMBASE (1974 to March 2006) and the references of traditional reviews. Experts in specialist units were also contacted.

Selection criteria

It was planned that any trial in which an attempt is made to allocate treatment for syphilis during pregnancy by a random or quasi-random method would be included in this review.

Data collection and analysis

Information was extracted using a data extraction sheet and this included entry criteria, the source of controls, and whether the authors stratified by the stage of pregnancy when the diagnosis of syphilis was made.

Main results

Twenty-nine studies met the criteria for detailed scrutiny. However, none of these met the pre-determined criteria for comparative groups and none included comparisons between randomly allocated groups of pregnant women.

Authors' conclusions

While there is no doubt that penicillin is effective in the treatment of syphilis in pregnancy and the prevention of congenital syphilis, uncertainty remains about what are the optimal treatment regimens.

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