A comparison study of two therapeutic protocols for neurosyphilis

In Morocco, neurosyphilis is a serious public health problem. In the neurol ogy service at the specialist hospital in Rabat, mio drug treatments were u sed. Treatment A consisted of infusion over a period of 4 h of 20 MUI of pe nicillin G per day for 3 weeks. Treatment B consisted of infusion over a pe riod of 6 h of 30 MUI of penicillin G per day for 10 days. Each treatment w as tested on a group of eight neurosyphilitic patients as first-line treatm ent. On the first day of treatment, both blood and CSF pharmacokinetics wer e sampled for each patient. Blood and CSF were taken within 24 h. Penicilli n G concentrations were determined by a microbiological method. The results obtained showed that perfusions of either 20 MUI or 30 MUI of penicillin a llowed the achievement of high serum concentrations. These increased progre ssively until reaching their maximum at T4 h for treatment A (from 92.33 to 106.38 mu g/ml). For treatment B, maximal concentration is obtained at T6 h (from 108 to 141.52 mu g/ml). Penicillin concentrations decreased immedia tely after stopping the perfusion. At CSF levels, penicillin G concentratio ns were identical to serum concentrations. However, one difference was obse rved: a one-hour difference between the serum and CSF peaks. The CSF peak w as achieved at T5 h for treatment h (0.063 to 2.25 mu g/ml) and at T7 h for treatment B (0.92 to 2.94 mu g/ml). The concentrations obtained were large ly superior to the CMI of Treponema pallidum for both treatment A and treat ment B, at 47 times and 82 times higher respectively. The recovery time of the patients was 14 h for treatment A and 24 h for B treatment. These resul ts have shown that therapeutic method B was more efficient than A. Moreover , the evolution of penicillin G's diffusion in the CSF during treatment, of cell counts, of protein level, of the VDRL test and of the gammaglobulin r ate was studied.