Azithromycin versus penicillin G benzathine for early syphilis

Azithromycin may be as effective as benzathine penicillin G for early syphilis.

The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment and selective reporting) and by imprecise results (wide confidence intervals).

Summary

A Cochrane review included 3 studies with a total of 793 subjects. The dose of benzathine penicillin G was either one (2.4 million units) or two intramuscular injections (1.2 million units each) and the dose of oral azithromycin is was 2 g or 4 g once. There was no statistically significant difference between azithromycin and benzathine penicillin treatment for early syphilis in the odds of cure (OR 1.04, 95% CI 0.69 to 1.56; 3 trials, n=790); nor any difference at 3 months (OR 0.97, 95% CI 0.62 to 1.50), 6 months (OR 1.09, 95% CI 0.76 to 1.54) or 9 months (OR 1.45, 95% CI 0.46 to 6.42). Subgroup analysis by primary and latent syphilis and by dose of azithromycin (2 g and 4 g) did not explain the variation between the study results. There were no statistically significant difference between azithromycin and benzathine penicillin in adverse events.

Clinical comment

There is an alert for bacterial drug resistance for macrolides.

Date of latest search: 28 November 2011

Ədəbiyyat

1. Bai ZG, Wang B, Yang K et al. Azithromycin versus penicillin G benzathine for early syphilis. Cochrane Database Syst Rev 2012;6:CD007270.