Meta-analysis of ceftriaxone compared with penicillin for the treatment of syphilis

• Penicillin is the gold standard for treating syphilis.
• This meta-analysis compared the efficacy of ceftriaxone vs. penicillin.
• 3-, 6- and 12-month response rates were not significantly different.
• Relapse rates, serofast rates and failure rates were not significantly different.
• Ceftriaxone and penicillin efficacy for syphilis are not significantly different.

Penicillin is the gold standard for treating syphilis. However, allergic reactions, poor drug tolerance and limited efficacy in patients remain a challenging problem. The objective of this meta-analysis was to compare the efficacy of ceftriaxone and penicillin based on data obtained from published randomised controlled trials (RCTs). The Cochrane Library, Medline, EBSCO, EMBASE and Ovid databases were searched for RCTs of ceftriaxone vs. penicillin for the treatment of syphilis. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were used to investigate the following outcome measures: 3-month response rate; 6-month response rate; 12-month response rate; relapse rate; serofast rate; and failure rate. Seven RCTs involving 281 participants (159 patients who received ceftriaxone and 122 patients who received penicillin) were included in the meta-analysis. There were no significant differences in 3-month response rate (RR = 1.12, 95% CI 0.89–1.42), 6-month response rate (RR = 1.02, 95% CI 0.75–1.38), 12-month response rate (RR = 1.04, 95% CI 0.82–1.32), relapse rate (RR = 0.91, 95% CI 0.45–1.84), serofast rate (RR = 0.69, 95% CI 0.22–2.12) or failure rate (RR = 0.66, 95% CI 0.03–15.76) in patients treated with ceftriaxone compared with those treated with penicillin. In conclusion, there is no evidence in the literature that ceftriaxone is less efficient than penicillin.