Neurosyphilis – Treatment Regimen — SCE Neurology MCQ
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Correct answer: C — IV benzylpenicillin (penicillin G) 18–24 million units daily for 14 days
Neurosyphilis requires high-dose intravenous benzylpenicillin (penicillin G) to achieve adequate CSF treponemicidal levels. The recommended regimen is 18–24 million units daily (3–4 million units every 4 hours) for 14 days. For penicillin-allergic patients, alternatives include IV ceftriaxone (2 g daily for 14 days) or desensitisation to penicillin. Oral doxycycline has uncertain CSF penetration and is not recommended for neurosyphilis. IM benzathine penicillin does not achieve adequate CSF levels. A: Oral doxycycline has unreliable CSF penetration. C: IM benzathine penicillin is for primary/secondary syphilis, not neurosyphilis. D: Amoxicillin is not recommended. E: 5 days of ceftriaxone is insufficient.
Reference: BASHH Syphilis Guidelines (2015); ABN Neurosyphilis Guidelines