Penicillin allergy in a patient with neurosyphilis creates a specific and important clinical problem. Because first-line therapy for neurosyphilis is penicillin-based, the presence of a documented allergy requires a defined management strategy rather than straightforward substitution.
This protocol addresses neurosyphilis in the setting of known or reported penicillin allergy. The allergy status directly determines which treatment pathway is appropriate and why simply switching to an alternative agent is not without risk.
The evidence-based strategy for this scenario centres on induction of tolerance to penicillin, making it possible to proceed with the established first-line regimen. This approach is preferred over substituting an alternative agent. The specific eligibility criteria, procedural details, and complete regimen are set out in the full structured protocol.
DOI: 10.1111/jdv.16946
In case of penicillin allergy, use of ceftriaxone may be a dangerous option although cross-allergies are not frequent.
Desensitization to penicillin (in fact, induction of tolerance) followed by the first-line regimen.
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