Treatment Administered to Newborns With Congenital Syphilis During the Period of Penicillin Shortage in Brazil

Abstract Background Between 2014 and 2016, Brazil experienced a severe shortage in penicillin supply, resulting in a lack of treatment among some pregnant women and newborns with syphilis and the use of non-evidence-based regimens. The aim of this study is to describe the different therapeutic regimens used in newborns with congenital syphilis during the period of penicillin shortage using a retrospective cross-sectional study design conducted in Fortaleza, Northeast Brazil. Methods Hospital medical records and case reporting forms of live births reported with congenital syphilis in 2015 and the associated maternal syphilis cases were reviewed during June 2017 to July 2018 from all public maternity hospitals in the city of Fortaleza. Results A total of 575 congenital syphilis cases were reported to the municipality of Fortaleza during 2015 and 469 (81.5%) were analyzed. Of these, only 210 (44.8%) were treated with a nationally-recommended treatment. As alternative therapeutic options, ceftriaxone was used in 65 (13.8%), Cefazolin in 15 (3.2%) and the combination of more than one drug in 179 (38.2%). Newborns with VDRL titers > 1:8 (p = 0.021), who had some clinical manifestation at birth (p = 0.003), who were born premature (p < 0.001), with low birth weight (p = 0.010), with jaundice indicative of the need for phototherapy (p = 0.019) and with hepatomegaly (p = 0.045) were more likely to be treated with penicillin according to national treatment guidelines compared to newborns treated with other regimens. Conclusion During the period of shortage of penicillin in Fortaleza, less than half of the infants with CS were treated with a nationally-recommended regimen, the remaining received treatment with medications available in the hospital of birth including drugs that are not part of nationally or internationally-recommended treatment recommendations.