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Comparison of serological responses to single-dose azithromycin (2 g) versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients in an area of low prevalence of macrolide-resistant Treponema pallidum infection.
J Antimicrob Chemother. 2016 Mar; 71(3):775-82.JA

Abstract

OBJECTIVES

Effectiveness of single-dose azithromycin (2 g) in the treatment of early syphilis among HIV-infected patients has rarely been evaluated in the era of combination ART.

METHODS

Consecutive HIV-infected patients with early syphilis, who received 2 g single-dose azithromycin or 2.4 MU benzathine penicillin G, between 2007 and 2014, were prospectively observed. Genotypic resistance to macrolides was determined in Treponema pallidum isolates identified from clinical specimens using PCR assays. Rapid plasma reagin (RPR) titres were determined at baseline and every 3 months after treatment. Primary outcome was a decline of RPR titre by ≥4-fold at 12 months after treatment.

RESULTS

During the study period, 162 HIV-infected patients with early syphilis received benzathine penicillin G and 237 patients received azithromycin. At 12 months follow-up, the serological response rate for penicillin and azithromycin groups was 61.1% and 56.5% (P = 0.41), respectively; respective response rate was 61.1% and 65.9% (P = 0.49) if we only included patients infected with T. pallidum not harbouring macrolide resistance in the azithromycin group. In multivariate analysis, RPR titres ≥1:32 (OR 2.56; 95% CI 1.55-4.21) and prior syphilis (OR 0.54; 95% CI 0.35-0.81) were predictors of serological response. Most common adverse effects of azithromycin included diarrhoea (52.7%), nausea (22.4%), abdominal pain (18.6%), bloating (17.7%) and lassitude/somnolence (27.4%).

CONCLUSIONS

In the setting of a low prevalence of macrolide-resistant T. pallidum, 2 g single-dose azithromycin achieved a similar serological response to benzathine penicillin G in HIV-infected patients with early syphilis. Major adverse effects of azithromycin were gastrointestinal symptoms and lassitude/somnolence.

Authors+Show Affiliations

Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan.Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan, Taiwan.Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.School of Medicine, Chung Shan Medical University and Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan Center of Infection Control, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.Center of Infection Control, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan Department of Medical Research, China Medical University Hospital, Taichung, Taiwan China Medical University, Taichung, Taiwan hcc0401@ntu.edu.tw.Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26604241

Citation

Yang, Chia-Jui, et al. "Comparison of Serological Responses to Single-dose Azithromycin (2 G) Versus Benzathine Penicillin G in the Treatment of Early Syphilis in HIV-infected Patients in an Area of Low Prevalence of Macrolide-resistant Treponema Pallidum Infection." The Journal of Antimicrobial Chemotherapy, vol. 71, no. 3, 2016, pp. 775-82.
Yang CJ, Tang HJ, Chang SY, et al. Comparison of serological responses to single-dose azithromycin (2 g) versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients in an area of low prevalence of macrolide-resistant Treponema pallidum infection. J Antimicrob Chemother. 2016;71(3):775-82.
Yang, C. J., Tang, H. J., Chang, S. Y., Hsieh, S. M., Lee, K. Y., Lee, Y. T., Sheng, W. H., Yang, S. P., Hung, C. C., & Chang, S. C. (2016). Comparison of serological responses to single-dose azithromycin (2 g) versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients in an area of low prevalence of macrolide-resistant Treponema pallidum infection. The Journal of Antimicrobial Chemotherapy, 71(3), 775-82. https://doi.org/10.1093/jac/dkv379
Yang CJ, et al. Comparison of Serological Responses to Single-dose Azithromycin (2 G) Versus Benzathine Penicillin G in the Treatment of Early Syphilis in HIV-infected Patients in an Area of Low Prevalence of Macrolide-resistant Treponema Pallidum Infection. J Antimicrob Chemother. 2016;71(3):775-82. PubMed PMID: 26604241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of serological responses to single-dose azithromycin (2 g) versus benzathine penicillin G in the treatment of early syphilis in HIV-infected patients in an area of low prevalence of macrolide-resistant Treponema pallidum infection. AU - Yang,Chia-Jui, AU - Tang,Hung-Jen, AU - Chang,Sui-Yuan, AU - Hsieh,Szu-Min, AU - Lee,Kuan-Yeh, AU - Lee,Yuan-Ti, AU - Sheng,Wang-Huei, AU - Yang,Shang-Ping, AU - Hung,Chien-Ching, AU - Chang,Shan-Chwen, Y1 - 2015/11/24/ PY - 2015/05/13/received PY - 2015/10/16/accepted PY - 2015/11/26/entrez PY - 2015/11/26/pubmed PY - 2016/10/26/medline SP - 775 EP - 82 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 71 IS - 3 N2 - OBJECTIVES: Effectiveness of single-dose azithromycin (2 g) in the treatment of early syphilis among HIV-infected patients has rarely been evaluated in the era of combination ART. METHODS: Consecutive HIV-infected patients with early syphilis, who received 2 g single-dose azithromycin or 2.4 MU benzathine penicillin G, between 2007 and 2014, were prospectively observed. Genotypic resistance to macrolides was determined in Treponema pallidum isolates identified from clinical specimens using PCR assays. Rapid plasma reagin (RPR) titres were determined at baseline and every 3 months after treatment. Primary outcome was a decline of RPR titre by ≥4-fold at 12 months after treatment. RESULTS: During the study period, 162 HIV-infected patients with early syphilis received benzathine penicillin G and 237 patients received azithromycin. At 12 months follow-up, the serological response rate for penicillin and azithromycin groups was 61.1% and 56.5% (P = 0.41), respectively; respective response rate was 61.1% and 65.9% (P = 0.49) if we only included patients infected with T. pallidum not harbouring macrolide resistance in the azithromycin group. In multivariate analysis, RPR titres ≥1:32 (OR 2.56; 95% CI 1.55-4.21) and prior syphilis (OR 0.54; 95% CI 0.35-0.81) were predictors of serological response. Most common adverse effects of azithromycin included diarrhoea (52.7%), nausea (22.4%), abdominal pain (18.6%), bloating (17.7%) and lassitude/somnolence (27.4%). CONCLUSIONS: In the setting of a low prevalence of macrolide-resistant T. pallidum, 2 g single-dose azithromycin achieved a similar serological response to benzathine penicillin G in HIV-infected patients with early syphilis. Major adverse effects of azithromycin were gastrointestinal symptoms and lassitude/somnolence. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/26604241/Comparison_of_serological_responses_to_single_dose_azithromycin__2_g__versus_benzathine_penicillin_G_in_the_treatment_of_early_syphilis_in_HIV_infected_patients_in_an_area_of_low_prevalence_of_macrolide_resistant_Treponema_pallidum_infection_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkv379 DB - PRIME DP - Unbound Medicine ER -