Congenital syphilis after maternal macrolide therapy in a presumed penicillin allergic patient. Time to change the Chilean governmental normative.

Resumen

Dear Editor, Syphilis during pregnancy has a high risk of transmission from mother to fetus, especially during early phases of infection. Consequences are disastrous and include abortion, stillborn, premature birth, intrauterine growth retardation, perinatal death, and congenital syphilis. (1) Penicillin remains the drug of choice and is the only validated therapeutic option for maternal syphilis. Treatment failures are of rare occurrence and may be explained by reinfection, HIV infection, incomplete doses, or placental insufficiency impeding drug delivery to the fetus. Pregnant women allergic to penicillin impose a therapeutic challenge due to reported failures to prevent congenital infection after macrolide treatment either by a low transplacental passage of the antibiotic compound or antibiotic resistance. (2,3) Alternatives such as doxycycline and tetracycline are contraindicated. Due to the great dependence on penicillin to achieve a therapeutic success in the fetus, guidelines from the CDC and other countries advocate for penicillin desensitization every time is possible. (4) Contrary to this recommendation, the Chilean normative does not consider desensitization as an option and impose erythromycin treatment. (5) Unfortunately, this option was published as a rule and not as a guideline. Read more....