Benzathine benzylpenicillin 1.2million unit powder for suspension for injection vials

ObjectiveThis scoping review explores existing clinical guidelines on administration of benzathine benzylpenicillin (Bicillin L-A, Pfizer Australia) in Australia and Aotearoa New Zealand. The objective is to understand existing delivery guidance to address variation in care and cultural safety considerations, to support messaging during periods of stockout and to inform planning for new administration techniques.Data sourcesSemi-structured Google search to identify publicly available clinical resources for each jurisdiction of Australia and for New Zealand. The search was conducted from October to December 2023.DesignGovernment reports and publicly available clinical guidelines were included. This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).ResultsThis guideline review demonstrates that guidance on administration of Bicillin L-A in Australia and New Zealand has strong, consistent, biomedical recommendations but underdeveloped cultural considerations. Across the features of culturally safe practice, existing clinical guidelines provide consistent information on biomedical knowledge and skills, less information about practising culturally safe behaviours and relatively little guidance on addressing power differentials.ConclusionsCultural safety inclusions should be considered for future administration guidance development.

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ObjectivesTo evaluate the effectiveness and safety of treatment for gestational syphilis during the third trimester on maternal and perinatal outcomes, according to the timing of administration relative to delivery, and assess the certainty of the body of evidence.Materials and methodsThis systematic review included randomized controlled trials, quasiexperimental studies, cohort studies, and case series involving women diagnosed with GS at 28 weeks’ gestation or later, treated with penicillin or other antibiotics. Search was done in 2023 and updated on June 2025. Two researchers selected studies and extracted data. We assessed the incidence of Congenital Syphilis and maternal treatment failure. Outcomes are presented by maternal and perinatal endpoints and treatment regimen.ResultsNo randomized controlled trials were identified. Ten cohort studies comprising 5438 women with GS and three case series of Congenital Syphilis were included. Benzathine penicillin G administered during the third trimester might be associated with a cumulative incidence of Congenital Syphilis of 8% (95% CI: 2–13%). The effectiveness of treatment administered 4 weeks before delivery remains uncertain. Aminopenicillins were possibly associated with a 43% incidence of Congenital Syphilis. Safety data were limited. Case series of foetuses with hidrops fetalis associated with gestational syphilis to mothers treated with a 10-day course of intravenous aqueous crystalline penicillin G showed seven newborns with complete response, suggesting prevention of Congenital Syphilis.ConclusionTreatment of GS with benzathine penicillin G during the third trimester is beneficial in reducing the risk of Congenital Syphilis. However, as its effectiveness is uncertain when administered fewer than 30 days before delivery, neonates born within this timeframe should continue to be managed in accordance with current guidelines for possible Congenital Syphilis. Aminopenicillins may be associated with a high rate of treatment failure. Alternative strategies to treat the fetus during the final four weeks of pregnancy are needed to reduce the risk of Congenital Syphilis.

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AimTo report the clinical characteristics, treatment and outcomes of active syphilitic uveitis in human immunodeficiency virus (HIV) positive patients and compare them with the previously published data.MethodsRetrospective analysis of the case series from an infectious disease center in southern China was conducted. Comprehensive review of previously published cases of HIV positive syphilitic uveitis was conducted using the PubMed and Web of Science databases and the references listed in the identified articles.ResultsTwelve HIV positive patients with active syphilitic uveitis were collected. All were male, with age of 36.3y (range 27 to 53y). Five (41.7%) had a history of syphilis, and three of them had received anti-syphilis treatment. Ocular manifestations included corneal epithelial defect (13%), complicated cataract (17.4%), vitreous opacity (82.6%), optic disc edema (26.1%), macular edema (30.4%), neuro-retinitis (43.5%), and retinal hemorrhage (26.1%). After standardized syphilitic treatment, intraocular inflammation was reduced and vision improved in all cases. The literature review summarizes 105 previously reported cases of HIV positive syphilitic uveitis. High serum rapid plasma regain (RPR) titers may be associated with severe uveitis and poor vision. Treatment with penicillin, ceftriaxone sodium, or penicillin plus benzylpenicillin instead of using benzylpenicillin alone can significantly improve best-corrected visual acuity (BCVA) in HIV positive ocular syphilis patients.ConclusionFor HIV positive syphilitic uveitis patients, prompt diagnosis and appropriate treatment and follow-up are paramount. In our series, the clinical manifestations are diverse. Syphilis patients treated by penicillin G or long-acting penicillin before may still develop syphilitic uveitis. Patients who relapse after long-term penicillin treatment can still benefit from penicillin G.

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Background: Syphilis can present with diverse clinical manifestations, earning the name "great imitator." Malignant syphilis (MS) is a rare, severe form of secondary syphilis, typically reported in immunocompromised patients, particularly those living with HIV. However, MS can occasionally occur in immunocompetent individuals, posing diagnostic challenges due to its atypical presentation. Methods: A case report is presented alongside a PubMed literature search using the terms "(malignant syphilis OR lues maligna) AND (immunocompetent) AND (case report OR case series)." No language or temporal restrictions were applied, yielding 18 relevant publications. Results: A 60-year-old HIV-negative man presented with fever, weight loss, papular lesions, and a single ulcer on the sternum. Serology was positive for syphilis, and PCR confirmed T. pallidum DNA in the lesion. Treatment with a single intramuscular dose of benzathine penicillin G led to prompt clinical and serological improvement. Literature review (n = 18) showed that MS in immunocompetent patients affects both sexes (55% male; mean age 37.1 years), often presents with ulceronodular or rupioid crusted lesions, and frequently involves systemic symptoms. Molecular diagnostics were rarely reported, with most diagnoses relying on histopathology and serology. Treatment with benzathine penicillin G was effective in all cases, and full recovery was achieved. Conclusions: MS can occur in immunocompetent, HIV-negative individuals without obvious risk factors. Clinicians should maintain a high index of suspicion in cases of systemic, cutaneous, or ocular manifestations suggestive of MS. Molecular assays can facilitate diagnosis and prevent unnecessary invasive procedures. Benzathine penicillin G remains the treatment of choice, demonstrating high therapeutic effectiveness. MS should be considered in the differential diagnosis of ulcerative or nodular dermatoses, regardless of immune status.

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