Treatment of patients with syphilis in various periods of the disease
1. Combined use of penicillin( ecmonovicillin) with one of bismuth preparations.
2. Repeated treatment with a single soluble penicillin( ECM) is desirable in conjunction with one of the methods of nonspecific therapy.
3. One bicillin( 1 or 3) and in combination with bismuth preparations.
In cases where it is necessary to avoid an exacerbation reaction, treatment should begin with bismuth preparations. After several injections of the bismuth drug, penicillin preparations are used;in the treatment of visceral and nerve syphilis, with damage to the organ of vision or hearing, penicillin preparations are used starting with the second course;The first course consists of injections of one of the bismuth preparations.
All patients with infectious forms of syphilis should take the first course in the hospital. The first course of treatment is advisable to carry out with water-soluble penicillin, administered every 2-3 hours for 50,000 units in a total dose in accordance with the weight of the patient and the period of the disease. At the end of the first course, the patient is discharged from the hospital and further treatment continues on an outpatient basis.
Preventative treatment of .Preventive( preventive) treatment should be carried out only in those cases when, as a result of confrontation, the possibility of infection has been established and no more than 3 weeks have elapsed since the moment of possible infection. If more than 3 weeks have passed, the treatment should be carried out as in the primary seronegative period, or leave these individuals under observation for 4-6 months. For preventive treatment, one course of water-soluble penicillin is recommended at a total dose of 8,000,000 units, followed by a course of bismuth treatment.
Treatment in the primary seronegative period .2 courses of penicillin-bismuth treatment are conducted( the course of penicillin and bismuth preparation is considered as one course).In the beginning, the course is carried out with water-soluble penicillin, then without interruption - a course of injections of biyohinol or bismorovol. Break between penicillin-bismuth courses for 1 month.
The course dose of penicillin( ECM) for treatment in this period of syphilis is calculated from the calculation of 1 000 000 units per 1 kg of the patient's weight. Patients, whose weight does not reach 60 kg, receive penicillin( ECM) at least 6 000 000 units per course. Penicillin is administered every 2-3 hours for 50,000 units. Ecomonocillin is administered by a two-stage method once a day for 600 000 units or in a hospital environment, 300,000 units 2 times a day.
Water-soluble penicillin( without bismuth preparations) is recommended to apply 3 courses with interruptions of 2-3 weeks between them.
Bicillin-1 or bicillin-3 is recommended to be used for 100 000 units per 1 kg of the patient's weight. Bicillin-1 is administered to 1 200 000 units every 5 days or 2 400 000 units every 9 days, bicillin-3 is administered respectively after 4 days and after 7 days. A single dose of bicillin is administered separately in half the dose to each buttock. Single dose should not exceed 2 400 000 units. Break between courses 2 - 3 weeks.
Treatment in the primary seropositive period .4 courses of penicillin-bismuth treatment are conducted with intervals between courses of 1 month. Water-soluble penicillin( without bismuth preparations) is applied repeated courses;only 5 courses with breaks between courses of 2-3 weeks.
Treatment with bicillin-1 or bicillin-3 includes 3 courses according to the method described.
Treatment of syphilis in the secondary fresh period .There are 5 courses of penicillin-bismuth treatment. Intervals between the courses are 1 month. Doses of penicillin( ECM) are calculated at the rate of 120 000, ED per 1 kg of the patient's weight. Patients weighing less than 60 kg are prescribed 7 200 000 units of penicillin per course. In the treatment with soluble penicillin, 5 courses are also applied with intervals between courses of 2-3 weeks.
In the treatment of bicillin-1 and bicillin-3 it is recommended to conduct 4 courses.
Treatment in the secondary recidivist period .Six courses of penicillin-bismuth treatment are conducted. Intervals between the courses are 1 month. Treatment with one water-soluble penicillin includes 8 courses at intervals of 2-3 weeks, bicillin-1 and bicillin-3 - 5 courses.
Treatment in the tertiary period , as well as with serostatic syphilis. There are 6 courses of penicillin-bismuth treatment or 8 courses of penicillin treatment only.
Treatment with bicillin-1 and bicillin-3 includes 5 courses. The dosage of penicillin is calculated from the calculation of 140 000 units per 1 kg of the patient's weight. Patients whose weight does not reach 60 kg, are prescribed 8 400 000 units of penicillin ED( ECM) for the course of treatment.
Trial treatment of .If there is a suspected specific damage to the visceral organs, nervous system, sensory organs, bones and joints, etc., when the diagnosis can not be confirmed by the presence of pale treponemes and serological reactions are negative, and the clinical picture of the disease does not accurately determine whether there is syphilis,you should resort to trial therapy, which, however, should be carried out quite intensively in accordance with the regimens for the treatment of late forms of syphilis.
Contraindications to the use of penicillin, ecmonovicillin, bicillin-1 and bicillin-3.These medications should not be used for patients suffering from bronchial asthma, chronic urticaria, hay fever, and other allergic conditions that poorly tolerated penicillin. Bicillin should not be used by people suffering from severe hypertension, who has had myocardial infarction in the past, with diseases of endocrine glands, acute gastrointestinal diseases, active tuberculosis, diseases of the hematopoietic system. Weak patients, the elderly( over 55 years of age) should not use a single dose of bicillin above 1,200,000 units. It is advisable the day before and before injection of bicillin to appoint ingestion into one of the antihistamines: dimedrol( 0.05 g) or diazoline( 0.1 g), pipolpene, etc.
Mixed treatment with arsenic and bismuth preparations .If treatment is done without the use of penicillin, then for primary seronegative syphilis, 3 courses of mixed treatment( novarsenol-myarsenol and bismuth preparations) are prescribed.
In primary seropositive syphilis, 6 courses of mixed treatment.
With secondary fresh and recurrent syphilis - 6 courses of mixed treatment. If sero-reactions do not turn negative into the beginning of the third course of treatment, then 8 courses of mixed treatment should be conducted.
With latent syphilis, treatment is similar to secondary recurrent syphilis.