What is the recommended treatment for neurosyphilis?

What is the recommended treatment for neurosyphilis?

• A. Acyclovir
• B. Penicillin IV
• C. Ceftriaxone
• D. Doxycycline

Answer: (B)

Neurosyphilis requires antibiotics that reach adequate levels in the central nervous system to eradicate Treponema pallidum within the CSF. Penicillin G given intravenously provides reliable CNS penetration and is the proven, preferred therapy. The standard approach is high-dose IV penicillin G totaling about 18–24 million units per day, administered in divided doses every 4 hours or as a continuous infusion, for 10–14 days. In some cases with persistent meningitis or more extensive CNS involvement, the duration may be adjusted. Alternatives exist, but penicillin remains the best option because of its proven CNS effectiveness against syphilis. Ceftriaxone has been used in penicillin-allergic patients, but it is not the gold standard for neurosyphilis. Doxycycline is not appropriate due to poor CNS penetration and insufficient activity in this setting, and acyclovir has no role in treating syphilis.

Neurosyphilis requires antibiotics that reach adequate levels in the central nervous system to eradicate Treponema pallidum within the CSF. Penicillin G given intravenously provides reliable CNS penetration and is the proven, preferred therapy. The standard approach is high-dose IV penicillin G totaling about 18–24 million units per day, administered in divided doses every 4 hours or as a continuous infusion, for 10–14 days. In some cases with persistent meningitis or more extensive CNS involvement, the duration may be adjusted.

Alternatives exist, but penicillin remains the best option because of its proven CNS effectiveness against syphilis. Ceftriaxone has been used in penicillin-allergic patients, but it is not the gold standard for neurosyphilis. Doxycycline is not appropriate due to poor CNS penetration and insufficient activity in this setting, and acyclovir has no role in treating syphilis.