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Table 1 Treatment of syphilis: US, UK and European recommendations

From: Emerging trends and persistent challenges in the management of adult syphilis

Stage US CDC- recommended regimens [11] UK recommended regimens [10] European recommended regimens [12] US alternative regimens [11] UK alternative regimens [10] European alterative regimens [12]
Early syphilis (primary, secondary, early latent of <1-2 years’ duration Benzathine penicillin G 2.4 million units IM single dose Benzathine penicillin G 2.4 million units IM single dose or Procaine penicillin G 600 000 units IM q24h for 10 days Benzathine penicillin G 2.4 million units IM single dose Doxycycline 100 mg or PO q12h for 14 days Ceftriaxone 1-2 g IM q24h for 10 days Doxycycline 100 mg or PO q12h for 14 days Erythromycin 500 mg or PO q6h for 14 days Ceftriaxone 500 mg IM or daily for 10 days Amoxicillin 500 mg PO q6h plus Probenecid 500 mg or po q6h for 14 days Procaine penicillin 600 000 units IM or daily for 10-14 days Doxycycline 200 mg or daily orally for 14 days Ceftriaxone 500 mg-1 g IM or IV daily for 10 days Azithromycin 2 g orally single dose
Late syphilis (latent syphilis of >1-2 years’ duration, cardiovascular, gummatous syphilis Benzathine penicillin G 2.4 million units IM weekly for 3 weeks Benzathine penicillin G 2.4 million units IM or weekly for 3 weeks Procaine penicillin 600 000 units IM q24h for 17 days Benzathine penicillin G 2.4 million units IM weekly for 3 dose Doxycycline 100 mg PO q12h for 28 days Doxycycline 100 mg or po q12h for 28 days Amoxicillin 2 g PO q8h plus probenecid 500 mg or po q6h for 28 days Procaine penicillin 600 000 units IM or daily during 17-21 days Doxycycline 200 mg PO daily during 21-28 days
Neurosyphilis Aqueous crystalline penicillin G 3-4 million units IV q4h for 10-14 days Procaine penicillin 1.8-2.4 million units IM q24h plus probenecid 500 mg or po q6h for 17 days Benzyl penicillin 3-4 million units IV q4h for 17 days Benzyl penicillin 3-4 million units IV q4h for 10-14 days Ceftriaxone 2 g IM or IV q24h for 10-14 days Doxycycline 200 mg po q12h for 28 days Amoxicillin 2 g PO q8h plus probenecid 500 mg or PO q6h for 28 days Ceftriaxone 2 g IM or IV q24h for 10-14 days Ceftriaxone 1-2 g or IV daily during 10-14 days Procaine penicillin 1.2-2.4 million units IM daily and Probenecid 500 mg po q6h for 10-14days
  1. IM: intramuscular, IV: intravenous, PO: by mouth, q4h: every 4 h, q6h: every 6 h, q12h: every 12 h, q24h: every 24 h, q48h: every 48 h, mg: milligrams, g: grams