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Ciab 187
Ciab 187
Brief Report
Clinical Efficacy of Cefixime for the treatment with ceftriaxone requires multiple daily intramus-
cular injections or intravenous administration, making treat-
Treatment of Early Syphilis ment adherence potentially challenging. There is a need to
Chrysovalantis Stafylis,1, Kori Keith,2 Shivani Mehta,2 David Tellalian,3 identify safe, effective, and convenient antibiotics to treat early
Pamela Burian,3 Carl Millner,3 and Jeffrey D. Klausner1
syphilis.
1
Department of Preventive Medicine, University of Southern California Keck School of
Cephalosporins could be good candidates for evaluation;
Medicine, Los Angeles, California, USA; 2Department of Medicine, David Geffen School
of Medicine, University of California, Los Angeles, Los Angeles, California, USA; and they are β-lactams that inhibit bacterial cell wall synthesis.
Received 11 December 2020; editorial decision 18 February 2021; published online 26 February
Participants
2021. In brief, the study took place in 5 primary care HIV commu-
Correspondence: Jeffrey D Klausner, Department of Preventive Medicine, University
of Southern California, Keck School of Medicine, 2001 N. Soto St., Los Angeles, CA 90033
nity clinics of the AIDS Healthcare Foundation in California.
(jdklausner@med.usc.edu). Enrollment was conducted between September 2018 and
Clinical Infectious Diseases® 2021;XX(XX):0–0 January 2020.
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases
Society of America. This is an Open Access article distributed under the terms of the Creative
Eligible participants were 18 years of age or older, with clin-
Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ ically or laboratory-confirmed primary, secondary, or early
by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any latent syphilis, with a rapid plasma reagin (RPR) (Arlington
medium, provided the original work is not altered or transformed in any way, and that the work
is properly cited. For commercial re-use, please contact journals.permissions@oup.com Scientific RPR test kit, Arlington, Virginia) titer ≥1:8. HIV-
DOI: 10.1093/cid/ciab187 infected individuals had a CD4 T-cell count ≥350 cells/μL and
Type of Treatment
within 4 hours of receiving the first dose of cefixime. The partic- our study, participants tolerated well the daily dosage of 800 mg
ipant was advised to stop treatment and was reevaluated at the divided into two 400-mg capsules. Only 1 adverse event was
clinic the following day. The skin rash resolved without addi- reported—a mild rash a few hours after receiving cefixime.
tional treatment. The participant was withdrawn from the study The high response rate of penicillin (94%) was not surprising.
and he received a single dose of 2.4 MU BPG, intramuscularly. Its efficacy has been established through long clinical experi-
ence and many previous studies [5]. Because of its high efficacy,
DISCUSSION
BPG remains the cornerstone of treatment for syphilis. Various
In this randomized noncomparative clinical study, 87% of par- studies have shown the efficacy of penicillin as being between
ticipants with early syphilis who received cefixime were treated 90% and 95% [11].
successfully. The study included an ethnically diverse group of However, there were several limitations to this study. This
participants with HIV infection who might be less responsive to pilot study was designed as a noncomparative study that utilizes
standard therapy but remain high-risk for new incident syph- an experimental group and a contemporaneous group; thus, it
ilis. Although this study had a modest sample size (N = 15), is not designed or adequately powered to show differences be-
our findings suggest that cefixime is a potentially efficacious tween the 2 groups of the study. Another limitation to this study
treatment for early syphilis. Further investigation of cefixime was the study sample size, which reduces the precision of the
is warranted in larger randomized trials to demonstrate clinical efficacy estimates.
efficacy. The initial results of this pilot study are encouraging.
One of the major benefits of using cefixime is its safety. Alternative and easy-to-administer treatment options for syph-
Common reported adverse reactions include mild gastrointes- ilis are urgently needed. Larger randomized controlled studies
tinal reactions, such as diarrhea, nausea, and vomiting [10]. In are important next steps toward evaluating the effectiveness of
Participant Number Intervention Arm Baseline RPR Titer 3-mo RPR Titer 6-mo RPR Titera 12-mo RPR Titer