GOGETA
Trying to get in PGY1
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dude has siphillis in the brain,but the last time he was administer PCN he went into anaphilatic shock
What is the best next step in management in this patient?
also talk in general how will you manage it
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| nightflight1945
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You have to desensitize the patient.
For treatment of syphilis in pregnancy and for neurosyphilis , the only approved medication is PENICILLIN , do desensitize and then treat!
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| hitesh
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Nice, i knew this was the case with pregnancy but didnt know abt neurosyphilis.. thank you 
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| ngaybinhyen
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 cool
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| nightflight1945
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| GOGETA
Trying to get in PGY1
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Treatment summary
* For patients with neurosyphilis who are not allergic, we recommend treatment with penicillin (Grade 1B). We use the standard regimen recommended by the CDC: Penicillin G (18 to 24 million units per day, administered as 3 to 4 million units IV every four hours or continuous infusion) for 10 to 14 days (show table 1). (See "Treatment" above).
* For patients with neurosyphilis who have a serious penicillin allergy (eg, anaphylaxis), we recommend desensitization to beta-lactams to eliminate anaphylactic sensitivity, as recommended by the CDC. This procedure should be performed in consultation with an allergist. After desensitization, penicillin G (18 to 24 million units per day, administered as 3 to 4 million units IV every four fours or continuous infusion) should be given for 10 to 14 days (Grade 1B).
* For patients with mild penicillin allergies, we suggest ceftriaxone (2 gm IV daily) for 10 to 14 days with careful observation for cross-reactivity (Grade 2C).
* LP should be performed three to six months after treatment and every six months thereafter until the until CSF WBC count is normal and CSF-VDRL is nonreactive. We suggest retreatment if these criteria are not met. In addition, we suggest retreatment if there is an increase in the CSF WBC count, or a fourfold increase in CSF-VDRL titer, in any follow-up CSF sample.
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| nightflight1945
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