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

doi:10.1093/jac/dkv379

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Title:	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
Authors:	Yang, Chia-Jui Tang, Hung-Jen Chang, Sui-Yuan Hsieh, Szu-Min Lee, Kuan-Yeh Lee, Yuan-Ti Sheng, Wang-Huei Yang, Shang-Ping Hung, Chien-Ching Chang, Shan-Chwen
Contributors:	Far Eastern Mem Hosp, Dept Internal Med Natl Yang Ming Univ, Sch Med Chi Mei Med Ctr, Dept Internal Med Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr Natl Taiwan Univ, Coll Med, Dept Clin Lab Sci & Med Biotechnol Natl Taiwan Univ Hosp, Dept Lab Med Natl Taiwan Univ, Coll Med Natl Taiwan Univ Hosp, Dept Internal Med Natl Taiwan Univ Hosp, Dept Internal Med, Hsin Chu Branch Chung Shan Med Univ, Sch Med Chung Shan Med Univ Hosp, Dept Internal Med Natl Taiwan Univ Hosp, Ctr Infect Control
Keywords:	ribosomal-rna a2058g united-states molecular subtypes secondary syphilis multicenter taiwan surveillance coinfection mutation gene
Date:	2016-03
Issue Date:	2018-01-18 11:37:50 (UTC+8)
Publisher:	Oxford Univ Press
Abstract:	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. 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 a parts per thousand yen4-fold at 12 months after treatment. 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% (PaEuroS=aEuroS0.41), respectively; respective response rate was 61.1% and 65.9% (PaEuroS=aEuroS0.49) if we only included patients infected with T. pallidum not harbouring macrolide resistance in the azithromycin group. In multivariate analysis, RPR titres a parts per thousand yen1:32 (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%). 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.
Relation:	Journal of Antimicrobial Chemotherapy, v.71 n.3, pp.775-782
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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