對Penicillin過敏之梅毒患者使用Ceftriaxone治療之療效分析：
系統性文獻回顧

蕭亞芝¹、陳曉芳¹、鄭如惠²、黃品叡^3,4,5

1李綜合醫療社團法人苑裡李綜合醫院 醫療部 專科護理師小組

2李綜合醫療社團法人苑裡李綜合醫院 護理部

3李綜合醫療社團法人大甲李綜合醫院 外科部 泌尿外科

4國立陽明交通大學 跨領域醫學博士學位學程

5亞洲大學 食品營養與保健生技學系

Efficacy of Ceftriaxone for the Treatment of Syphilis in Penicillin-Allergic Patients:
A Systematic Review

Ya-Chih Hsiao¹, Hsiao-Fang Chen¹, Ru-Hui Cheng², Pin-Jui Huang^3,4,5

1Division of Nursing Participants, Department of Medical Affairs, Yuanli Lee Hospital

2Nursing Department, Yuanli Lee Hospital

3Division of Urology, Department of Surgery, Dajia Lee Hospital

4Ph.D. Program in Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei

5Department of Food Nutrition and Health Biotechnology, Asia University, Taichung

Introduction

Penicillin remains the first-line treatment for syphilis at all stages due to its proven efficacy and long-term clinical experience. However, management becomes challenging in patients with documented penicillin allergy, especially when desensitization is not feasible. Alternative regimens such as doxycycline and tetracycline are commonly used, but concerns exist regarding compliance and treatment efficacy. Ceftriaxone, a third-generation cephalosporin with good central nervous system penetration and long half-life, has emerged as a potential alternative therapy for syphilis. This systematic review evaluates the efficacy and clinical outcomes of ceftriaxone in treating syphilis among patients with penicillin allergy.

Materials and Methods

A systematic literature review was conducted using PubMed, Embase, and Cochrane databases to identify studies evaluating ceftriaxone for syphilis treatment. Keywords included “ceftriaxone,” “syphilis,” “penicillin allergy,” and “treatment efficacy.” Studies included randomized controlled trials, cohort studies, and meta-analyses comparing ceftriaxone with penicillin or other alternative treatments. Outcomes assessed included serological response rate, treatment failure, and adverse events.

Results

Multiple studies and meta-analyses demonstrated that ceftriaxone has comparable efficacy to penicillin in treating early syphilis, with similar serological response rates and treatment success rates. In some studies, ceftriaxone showed higher serological response rates at certain follow-up intervals compared with penicillin. Typical treatment regimens involved ceftriaxone 1–2 g administered intravenously or intramuscularly daily for 10–14 days. Ceftriaxone also demonstrated effectiveness in neurosyphilis due to its favorable cerebrospinal fluid penetration. However, treatment failure was occasionally reported, particularly in patients with HIV infection or latent syphilis. Overall, ceftriaxone was generally well tolerated, and adverse events were uncommon. Nevertheless, concerns remain regarding potential cross-reactivity between cephalosporins and penicillin in allergic patients, although the risk is relatively low.

Discussion

Ceftriaxone appears to be an effective alternative treatment for syphilis in patients with penicillin allergy, particularly for early syphilis and neurosyphilis. Compared with doxycycline or tetracycline, ceftriaxone may provide higher treatment success rates and better compliance due to parenteral administration. However, penicillin remains the gold standard treatment, especially for pregnant patients and late-stage syphilis, where desensitization is still recommended. The optimal dosing regimen and treatment duration of ceftriaxone remain unclear due to variations across studies.

Conclusion

Ceftriaxone is an effective alternative therapy for syphilis in patients with penicillin allergy, demonstrating comparable serological cure rates to penicillin in multiple studies. While not replacing penicillin as first-line therapy, ceftriaxone represents a valuable treatment option when penicillin cannot be used. Further large-scale randomized controlled trials are needed to establish standardized treatment regimens and long-term outcomes.