Deciphering the serological response to syphilis treatment in men living with HIV.

OBJECTIVE: To examine syphilis serology after treatment in people living with HIV. No unanimous guidelines exist in the era of increasing coinfection. DESIGN: Retrospective review using a tertiary care clinic in Toronto from 2000 to 2017. METHODS: The 2015 Centers for Diseases Control and Prevention syphilis guidelines were used to define an adequate serologic response. Cumulative distribution estimates and proportional hazards models accounting for interval censoring estimated the time to serologic response and seroreversion. Multistate models were used to investigate extended periods of serofast serology. RESULTS: A total of 171 patients with syphilis met our inclusion criteria (16 primary, 53 secondary, 26 early latent, 46 late latent, 30 neurosyphilis). Serologic response was achieved by 12 months for 65 (94%) patients and by 12-18 months for four (6%) patients with primary/secondary syphilis. For latent and neurosyphilis, 94 (92%) achieved serologic response by 24 months and one (1%) at 24.1 months. 84 (49%) patients achieved seroreversion with a median (95% confidence interval) time of 2 (1.44, 2.68) years. Latent syphilis was associated with a lower likelihood of achieving serologic response [hazard ratio (HR) = 0.52, P = 0.05] and seroreversion (HR = 0.27, P < 0.001) compared with primary/secondary syphilis. The probability of moving from a new infection state to a serofast state within 1 year was high (0.65) but the 1-year probability of transitioning from a serofast state to seroreversion was low (0.27). CONCLUSION: The majority of people living with HIV infected with syphilis will achieve an adequate serologic response as per the Centers for Diseases Control and Prevention guidelines. Seroreversion was observed in about half but can take years to occur.

[Experience of using bacteriophages and bitsillin-5 to reduce the incidence of respiratory diseases of bacterial ethiology in military personnel].

The authors defined epidemiological efficacy and safety of the use of bacteriophages(streptococcal, staphylococcal, piobakferiophage multipartial) and bitsillin-5 to reduce tonsillitis morbidityand other respiratory diseases with bacterial etiology in groups of servicemen during their formationagainst increase of seasonal morbidity. The results of the use of these preventive agents were evaluatedby a comparative analysis of this disease in experimental and control groups. In total 510 healthy conscriptswere involved into the study. The effectiveness of prophylactic use of bacteriophages and bitsillin-5, whichprovided a reduction in the incidence of respiratory infections of bacterial ethiology, tonsillitis, and otherrespiratory diseases is showed. Recommendations on the choice of drugsfor the prevention of these infections,methods and organization of their application in organized groups are given.

[Experience of bicillin prevention of acute respiratory diseases in the training center].

The article describes the experience of emergency prevention of acute respiratory diseases among the young recruits by intramuscular injection of BICILLIN-5. This method allowed in winter 2011 to reduce the number of diseases caused by pneumococcus, staphylococcus and streptococcus significantly. Considering the polyetiology of pneumonia, acute bronchitis and acute respiratory infections, the lack of specific means of prevention against the majority of them, as well as the role of the low resistance of the organism in the military development of acute respiratory diseases, it is proposed to use antiviral drugs and immunotropic funds in addition to chemoprophylaxis and vaccination.

[A comparative evaluation of the pharmacokinetics of different forms of benzathine benzylpenicillin]. / Sravnitel'naia otsenka farmakokinetiki razlichnykh lekarstvennykh form benzatin benzilpenitsillina.

Comparative randomized opened pharmacokinetic evaluation of benzathine benzylpenicillin in three dosage forms was performed. Benzathine benzylpenicillin was used as extencilline (2.4 million U or 1.2 million U, "Rhône-Poulenc Rorer", France) and as bicillin-5 (1.5 million U, "Synthesis" Russia). 33 patients were included in investigation (23 women and 10 men aged 16-60 years). 25 persons had verified rheumatism without blood circulation failure signs, 4--had chronic tonsillitis and 4 were healthy volunteers. Benzylpenicillin concentration was estimated by microbiology test in blood samples taken at 1, 3, 24 hours and 7, 14 and 21 days after intramuscular drug injection. After 2.4 million U extencilline injection (12 patients) its concentration, was at the inhibition level for beta-hemolytic streptococcus group A (25 ng/ml) for 3 weeks-period in 83.3 per cent of patients. After 1.2 million U extencilline injection (10 patients) or 1.5 million U bicillin-5 injection (12 patients) the above mentioned concentration was achieved on the 21st day in 30 and 0 per cent of patients respectively. Thus the treatment with benzathine benzylpenicillin at the 1.2 million U dose in the form of extencilline or bicillin-5 doesn't provide adequate antistreptococcal concentration in blood in prolonged period and is not suitable for correct rheumatism prophylaxis in adult patients.

Randomized evaluation of benzathine penicillin V twice daily versus potassium penicillin V three times daily in the treatment of group A streptococcal pharyngitis. Pharyngitis Study Group.

In a randomized, prospective, multicenter study the clinical and bacteriological efficacies of three dosage schedules with two different salts of oral penicillin V suspensions (regimen 1: potassium salt of penicillin V, 50,000 U/kg of body weight per day in three divided doses; regimen 2: benzathine salt of penicillin V, 50,000 U/kg of body weight per day in two divided doses; and regimen 3: benzathine salt of penicillin V, 100,000 U/kg of body weight in two divided doses) for the treatment of streptococcal pharyngitis were evaluated. Children with clinical signs of acute pharyngitis and a positive throat culture for group A beta-hemolytic streptococci (GABHS) were eligible. There was no difference between the treatment groups with respect to the overall clinical success rate. Eradication of the original serotype of GABHS from throat cultures was achieved in 87.1% (regimen 1), 85.5% (regimen 2) and 87.7% (regimen 3) of patients. The incidence of potential drug-related adverse events was significantly higher in patients treated with regimen 3. The results of this and earlier studies strongly suggest that oral penicillin given twice daily should be the recommended treatment for the initial treatment of pharyngitis due to GABHS. Doubling the total daily dose is not beneficial in the usual clinical setting. Because of its favorable pharmacokinetics, the benzathine salt of penicillin V appears to be well suited for a twice-a-day dosage schedule.

[The epidemic process of an acute streptococcal respiratory infection in large organized collectives of children]. / Epidemicheskii protsess ostroi respiratornoi streptokokkovoi infektsii v krupnykh detskikh organizovannykh kollektivakh.

The study of the specific features of the development of the epidemic process of scarlet fever, tonsillitis, and acute respiratory diseases (ARD) in two large organized groups of children revealed the presence of some differences which depended on the character of prophylactic measures taken in these groups. Thus, in the absence of prophylaxis with bicillin a pronounced increase in the level of carriership, accompanied by an increase in the infective capacity of carriers, was noted. This resulted in a high level and unfavorable dynamics of morbidity in scarlet fever, tonsillitis, and ARD. On the contrary, the use of prophylaxis with bicillin ensured the stability of the level of carriership, while the infective capacity of carriers was not pronounced. At the same time a rise in ARD morbidity was insignificant, and morbidity in scarlet fever and tonsillitis was reduced to nil.

Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis.

A multicenter, double-blind, randomized, placebo-controlled trial was conducted to determine whether the addition of penicillin was superior to patient education and anti-inflammatory drug therapy for relief of the acute discomforts of pharyngitis caused by group A beta-hemolytic streptococcus (GABHS). One hundred seventy-eight patients, aged 4 to 29 years, received appropriate symptomatic therapy, including specific doses of aspirin or acetaminophen, plus penicillin (91 patients) or placebo (87) for the initial 48 hours of illness. All had 24-hour office and 48-hour telephone reevaluations. In 123 patients (57 with clinically severe pharyngitis), throat cultures yielded GABHS. Penicillin provided a margin of 20% improvement over anti-inflammatory therapy for the complaint of sore throat only after 48 hours of treatment (for the 123 patients with GABHS, p = 0.01; for the 57 with both severe pharyngitis and GABHS, p = 0.05). No significant improvement was noted for fever, malaise, odynophagia, exudate, adenitis, or pharyngitis. The failure of penicillin to provide much additional benefit makes its routine early prescription specifically for symptomatic relief questionable.

Absorption of penicillin V from mixture formulations. Comparison of potassium and benzathine salts.

The absorption rate and serum level curves of two commercial phenoxymethylpenicillin mixture preparations were compared in adult volunteers. Both the potassium salt (Primcillin) and the benzathine salt (V-Pen ped forte) of V-penicillin were rapidly absorbed and the mean peak serum levels were obtained with both preparations within the first hour after single dose administration. The mean peak level obtained with the potassium salt was several-fold higher (p less than 0.001) and was also reached within a shorter time than that of the benzathine preparation. These results confirm the earlier evidence, obtained with other formulae, for the superior bioavailability of the potassium salt of V-penicillin as compared to most other derivatives used in V-penicillin mixtures.

High-performance liquid chromatographic analysis of penicillin V benzathine oral suspensions.

A rapid high-performance liquid chromatographic assay for penicillin V content of penicillin V benzathine bulk drug and oral suspensions is described. Dilution of the oral suspension with methanol containing 1,3,5-trimethoxybenzene as the internal standard allowed for direct analysis on a reversed-phase column with a mobile phase of 53% methanol in 0.05 M aqueous pH 3.5 phosphate buffer. A relative standard deviation of less than 1% was obtained on commercial formulations, and the system was linear over a range 10-40 microgram injected.