Effective Alternative Treatment Regimens for People With Infectious Syphilis: A Systematic Review and Network Meta-Analysis.
Anna Cvetkovic, Laura Erdman, Rochelle Johnstone et al.
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In 30 seconds
This systematic review and network meta-analysis evaluated alternative treatment regimens for infectious syphilis in adults and adolescents. It included 14 randomized controlled trials and 20 observational studies. Doxycycline was found to be the best-supported alternative to benzathine penicillin, with an odds ratio of 6.88 favoring its use compared to standard care, although the evidence quality was low.
Key findings
- Doxycycline showed an odds ratio of 6.88 compared to standard care in the network meta-analysis.
- Benzathine penicillin was superior to benzathine penicillin alone, but evidence quality was low.
- All other treatment comparisons did not show statistically significant differences in cure rates.
- The level of evidence was low for RCTs and very low for observational studies.
Why it matters
With rising syphilis rates and shortages of benzathine penicillin, understanding alternative treatment options is crucial for effective management. This review highlights doxycycline as a potential alternative, although clinicians should consider the low quality of evidence.