Benzathine Penicillin Treatment for Maternal Syphilis

WHO Guidelines strongly recommend intramuscular injection of Benzathine penicillin G (BPG) as the most effective treatment for maternal syphilis

*Except in case of patient being allergic to penicillin*

Assessment of Patient Eligibility for Treatment of syphilis

(1) Assess Test Results:

Patient should have tested reactive for Syphilis via ANY ONE of RPR/VDRL/TPHA/PoC/Dual RDT

Identify the stage of syphilis in client

EARLY STAGE: Mouth Sores/Rash or asymptomatic:infected for <2years or[RPR Titre <1:8]

LATENT STAGE: Asymptomatic infected for=>2years or an unknown period[RPR Titre>=1:8]

Ensure the client is not allergic to penicillin or cephalosporin,and has no history of anaphylaxis

Pregnant women found reactive on ANYONE {or More}of PoC/Dual RDT/RPR/VDRL/TPHA(in any titre)Tests,should be treated with Benzathine penicillin G (BPG).

(2) Determine BPG Dose:

RPR Titre Value(Stage of Infection)

If Titre is less than<1:8 or {early stage

Recommended Regimen: 2.4M Units of benzathine penicillin G(BPG)intramuscular injection Single Dose.

Alternative Regimen: Erythromycin 500mg/doses orally, 4doses/day for 15 days OR Azythromycin 2g orally in 1 dose.

If Titre is greater than or Equal to =>1:8 or {Latent stage}

Recommended Regimen: Three intramuscular injections 2.4M Units of benzathine penicillin G(BPG)weekly for 3 weeks.

Alternative Regimen: Erythromycin 500mg/doses orally, 4doses/day for 30 days OR Azythromycin 2g orally in 1 dose.

(3) Administer intramuscular (BPG) injection

Penicillin Sensitivity test may be conducted before administering penicillin to patient-in case of adverse signs {refer to list below} consider alternate treatment regimen as mentioned in step 2 above.

Administer into ventrogluteal, dorsogluteal, area of buttock or vastus lateralis of thigh alternating on each,

Administration (BPG should not be given into the Deltoid Muscles of the upper arm)

Deliver Medication at slow, steady rate, preferably over 2-3 minutes.

Never administer BPG via intravenous administration: Take special precautions to avoid intravascular injection

Avoid intramuscular injection of this suspensions near major nerves or blood vessels because it may cause neuromuscular damage

(4) Observe patient for Signs of Anaphylactic Shock

In extremely rare cases (0.01% chances)BPG may cause Anaphylaxis

observe a patient for a minimum of 10 minutes for any of the following symptoms

Discomfort in Breathing

Shock

Itchy Rashes of Hives

In case of Anaphylactic Shock

1 Assess Airway, Breathing and Circulation: Perform CPR if Necessary

2 Call for Help, Contact Emergency Services if required.

3 Inject Adrenaline intramuscularly (0.5ml for adult and 0.3ml for elderly)repeat in 5-10 minutes until response is adequate:Recommended dilution for adrenaline is 1:1000(1mg/ml)

4 Check BP and Pulse every 5-10 minutes

5 Give Hydro cortisone 250 mg intramuscular

6 Give Chlorophenramine 10-20 mg or Dyphenhydramine.50-100mg intramuscular

7 Transfer patient to Hospital or nearest Emergency ward

8 Repeat Adrenaline if necessary

9 Record all details of treatment Give Copy to the hospital as well as the patient

NOTE:

All this steps should be followed by a professional Medical health practitioner or the injection should be taken under professional Medical health practitioner only and Benzathine Penicillin should be taken under the supervision of Professional Doctors.

Benzathine Penicilin Treatment for Maternal Syphilis