Tratamento da sífilis congênita e sua repercussão na rotina neonatal / Treatment of congenital syphilis and its impact on the neonatal routine

Introdução: A sífilis é uma doença infecto-contagiosa transmitida pela via sexual (sífilis adquirida) e verticalmente (sífilis congênita) durante a gestação pela placenta da mãe para o feto. Objetivos: Apresentar o tratamento proposto pelo Ministério da Saúde através do protocolo clínico atual para Sífilis transmitida verticalmente e relatar se foi uma opção viável, já que não havia a disponibilidade da Benzilpenicilina Procaína em todos os estados brasileiros; analisar quantas internações por um período mínimo de 10 dias poderiam ter sido evitadas se houvesse a disponibilidade da Benzilpenicilina Procaína conforme está no protocolo do Ministério da Saúde sendo notada a falta de tal medicação, prioritariamente, no Estado de São Paulo. Método: Estudo retrospectivo, investigativo, com revisão de prontuários de 23 gestantes com Sífilis e os respectivos recém-nascidos durante todo o ano de 2020, na maternidade de um hospital escola em Catanduva-SP. Resultados: Todos os recém-nascidos de mães com Sífilis na gestação recebiam o tratamento e/ou o seguimento para Sífilis Congênita de acordo com o teste - VDRL colhido ao nascimento. O tratamento para Sífilis Congênita sem Neurossífilis foi realizado com Benzilpenicilina Cristalina durante 10 dias, por via endovenosa, em quatorze bebês (56,5%). Destas 14 internações, apenas um caso de Sífilis Congênita com Neurossífilis realmente necessitava permanecer internada para tratamento endovenoso com Benzilpenicilina Cristalina. Uma mãe evadiu-se do hospital com o recém-nascido e não completou o tratamento no hospital-escola deste estudo, e para oito (34,8%) bebês definiu-se apenas o seguimento ambulatorial como conduta de acordo com as diretrizes do Ministério da Saúde. Em relação às intercorrências acometidas aos bebês que ficaram internados foram basicamente a dificuldade de amamentação e a perda do acesso venoso periférico com recorrência. Conclusão: A discordância nas Diretrizes do Ministério da Saúde para o tratamento da Sífilis Congênita, mesmo as mais atualizadas (2020), ocorre em decorrência da indisponibilidade desta medicação de baixo custo, Benzilpenicilina Procaína, aplicada intramuscular, o que facilita sua administração a nível de Unidades Básicas de Saúde e dispensa a internação hospitalar de bebês com necessidade de tratamento para a Sífilis Congênita sem Neurossífilis. Com isso, o trabalho sugere que a disponibilização da Benzilpenicilina Procaína para o tratamento dos casos simples de Sífilis Congênita culminará em incontáveis benefícios para o binômio mãe-bebê

Introduction: Syphilis is an infectious contagious disease transmitted sexually (acquired syphilis) and vertically (congenital syphilis) during pregnancy through the placenta from the mother to the fetus. Objectives: To prove whether the treatment proposed by the Ministry of Health through the current clinical protocol for vertically transmitted syphilis is a viable option, since Benzylpenicillin Procaine is not available in all Brazilian states; and to analyze how many hospitalizations for a minimum period of 10 days could have been avoided if Benzylpenicillin Procaine had been available as per the Ministry of Health protocol, with the lack of such medication being noted, primarily, in the State of São Paulo. Method: Retrospective, investigative study, reviewing the medical records of 23 pregnant women with Syphilis and their newborns throughout the year 2020, in the maternity hospital of a teaching hospital in Catanduva-SP. Results: All newborns of mothers with Syphilis during pregnancy received treatment and/or follow-up for Congenital Syphilis according to the test - VDRL collected at birth. Treatment for Congenital Syphilis without Neurosyphilis was performed with crystalline Benzylpenicillin for 10 days, intravenously, in fourteen babies (56.5%). Of these 14 hospitalizations, only one case of Congenital Syphilis with Neurosyphilis really needed to remain hospitalized for intravenous treatment with Crystalline Benzylpenicillin. One mother escaped from the hospital with the newborn and did not complete the treatment at the Hospital-Escola, and eight (34.8%) babies were defined only as outpatient follow-up as conduct in accordance with the guidelines of the Ministry of Health. Regarding the complications affected by the babies who were hospitalized, they were basically the difficulty in breastfeeding and the loss of peripheral venous access with recurrence. Conclusion: Disagreement in the Guidelines of the Ministry of Health for the treatment of Congenital Syphilis, even the most up-to-date ones (2020) occurs due to the unavailability of this low-cost medication, Benzylpenicillin Procaine, applied intramuscularly, which facilitates its administration at the Unit level Health Basics and waives the hospitalization of babies in need of treatment for Congenital Syphilis without Neurosyphilis. With this, the work suggests that the availability of Procaine Benzylpenicillin for the treatment of simple cases of Congenital Syphilis will culminate in countless benefits for the mother baby binomial

Introducción: La sífilis es una enfermedad infectocontagiosa de transmisión sexual (sífilis adquirida) y vertical (sífilis congénita) durante el embarazo a través de la placenta de la madre al feto. Objetivos: Probar si el tratamiento propuesto por el Ministerio de Salud a través del protocolo clínico vigente para la sífilis de transmisión vertical es una opción viable, ya que la Bencililpenicilina Procaína no está disponible en todos los estados brasileños; y analizar cuántas hospitalizaciones por un período mínimo de 10 días se podrían haber evitado si la bencililpenicilina procaína hubiera estado disponible según el protocolo del Ministerio de Salud, observándose la falta de dicha medicación, principalmente, en el estado de São Paulo. Método: Estudio retrospectivo, investigativo, revisando las historias clínicas de 23 gestantes con Sífilis y sus recién nacidos a lo largo del año 2020, en la maternidad de un hospital universitario de Catanduva-SP. Resultados: Todos los recién nacidos de madres con Sífilis durante el embarazo recibieron tratamiento y/o seguimiento para Sífilis Congénita según prueba - VDRL recogido al nacer. El tratamiento de la Sífilis Congénita sin Neurosífilis se realizó con Bencilpenicilina cristalina durante 10 días, por vía intravenosa, en catorce bebés (56,5%). De estas 14 hospitalizaciones, solo un caso de Sífilis Congénita con Neurosífilis necesitó realmente permanecer hospitalizado para recibir tratamiento intravenoso con Bencilpenicilina Cristalina. Una madre se escapó del hospital con el recién nacido y no completó el tratamiento en el hospital escuela en este estudio, y ocho (34,8%) bebés fueron definidos solo como seguimiento ambulatorio como conducta de acuerdo con las directrices del Ministerio de Salud. En cuanto a las complicaciones que afectaron a los bebés que fueron hospitalizados fueron básicamente la dificultad en la lactancia y la pérdida del acceso venoso periférico con recurrencia. Conclusión: La inconformidad en las Directrices del Ministerio de Salud para el tratamiento de la Sífilis Congénita, incluso las más actualizadas (2020) se da por la indisponibilidad de este medicamento de bajo costo, la Bencilpenicilina Procaína, de aplicación intramuscular, que facilita su administración a nivel de Unidad Básicos de Salud y renuncia a la hospitalización de bebés con necesidad de tratamiento por Sífilis Congénita sin Neurosífilis. Con ello, el trabajo sugiere que la disponibilidad de la Bencilpenicilina Procaína para el tratamiento de casos simples de Sífilis Congénita culminará en innumerables beneficios para el binomio madre-bebé

Uso racional de antibióticos en las faringoamigdalitis agudas / Rational use of antibiotics in acute pharyngotonsillitis

Objetivo: evaluar si una intervención farmacéutica formativa permite mejorar la utilización de antibióticos en las faringoamigdalitis agudas (FAA) pediátricas. Material y métodos: estudio de intervención antes-después. Se analizaron las prescripciones de antibióticos (J01) asociadas a los códigos CIAP faringitis-amigdalitis estreptocócica (FAE) (R72), faringitis aguda (R74) y amigdalitis aguda (R76) antes y después de una intervención farmacéutica formativa sobre pediatras de Atención Primaria (AP). Se calculó el porcentaje de prescripciones de antibióticos de primera elección (penicilina V, penicilina G o amoxicilina) asociadas al código CIAP R72 y CIAP R74-R76. La intervención farmacéutica consistió en un taller formativo y sesiones clínicas. Resultados: la prescripción de antibióticos sistémicos disminuyó de forma significativa en el periodo posintervención respecto al preintervención (44,1% frente a 46,2% (p = 0,014)). Se observó un aumento significativo del porcentaje de prescripciones de antibióticos de primera elección asociadas al código CIAP R72 (84,3% frente a 57,6%; p <0,001) y una disminución de las prescripciones de amoxicilina/clavulánico (13,6% frente a 22,9%; p <0,001) y de azitromicina (1,0% frente a 11,3%; p <0,001) asociadas al código CIAP R72. Conclusiones: las prescripciones de antibióticos de los pediatras de AP disminuyeron, optimizándose el uso de antibióticos de primera elección en las FAE (AU)

Objective: to assess whether a pharmaceutical education intervention achieved a reduction and improvement in the prescription of antibiotics for management of paediatric acute pharyngitis (PAP).Material and methods: we conducted a pre-post intervention study. We analysed the prescription of systemic antibiotics (J01) associated with diagnoses corresponding to CIAP codes for streptococcal pharyngitis-tonsillitis (R72), acute pharyngitis (R74) and acute tonsillitis (R76) before and after a pharmaceutical education intervention on primary care (PC) paediatricians. We calculated the percentage of antibiotic prescriptions corresponding to first-line antibiotics (penicillin V, penicillin G or amoxicillin) associated with CIAP code R72 and CIAP codes R74-R76. The pharmaceutical education intervention consisted of a training workshop and clinical sessions.Results: the prescription of systemic antibiotics decreased significantly in the post-intervention period compared to the pre-intervention period (44.1% versus 46.2%; p = 0.014). There was a significant increase in the percentage of first-line antibiotic prescriptions out of the total prescriptions associated with CIAP code R72 (84.3% versus 57.6%; p = 0.000) and a decrease in the proportion of prescriptions of amoxicillin-clavulanic acid (13.6% versus 22.9%; p <0.001) and azithromycin (1.0% versus 11.3%; p <0.001) over the total prescriptions associated with CIAP code R72.Conclusions: there was a decrease in antibiotic prescription by PC paediatricians with improvement in the prescription of first-line agents for PAP. (AU)

Pharmacokinetic/pharmacodynamic evaluation of the antimicrobial therapy of pneumococcal invasive disease in adults in post-PCV13 vaccine period in Madrid, Spain.

The objective of our study was to evaluate by pharmacokinetic/pharmacodynamic (PK/PD) analysis, if the antimicrobials used for the treatment of invasive pneumococcal disease (IPD) in adults, including meningitis, are adequate considering the susceptibility profile of S. pneumoniae in Spain after the implantation of PVC13 vaccine. Pharmacokinetic parameters of benzylpenicillin and cefotaxime were obtained from the literature, and susceptibility data of invasive S. pneumoniae strains recovered in 2017 (post-PCV13 vaccination period) were provided by the Public Health Regional Laboratory of Madrid. We have also studied levofloxacin because it is used to treat pneumococcal pneumonia previously to be diagnosed as bacteremic pneumonia. Monte Carlo simulation was used to estimate the probability of target attainment (PTA) and the cumulative fraction of response (CFR). All doses of benzylpenicillin except 2 mU q6h provide a high probability of treatment success for MIC values ≤ 1 mg/L; 4 mU q4h is even useful for MIC values up to 4 mg/L. This high dose, used for the treatment of meningitis, also provides high probability of treatment success for MIC ≤ 0.5 mg/L. At the susceptibility EUCAST breakpoint (≤ 0.5 mg/L), cefotaxime provides a high rate of PD target achievement, even at the lowest dose (1 g q8h). For meningitis, 2 g q6h ensures probabilities of target attainment ≥90% for MIC up to 1 mg/L. Our study confirms that after the implementation of PCV13 vaccine, the treatment with benzylpenicillin and cefotaxime provides high probability of the therapy success of IPD, including meningitis.

Benzylpenicillin Serum Concentrations in Neonates With Group B Streptococci Sepsis or Meningitis: A Descriptive Cohort Study.

BACKGROUND: Adequate dosage recommendations are imperative for successful treatment of invasive infections. We evaluated the occurrence of sub- and supratherapeutic serum and cerebrospinal fluid (CSF) concentrations of benzylpenicillin (BPEN) in neonates treated for a severe group B streptococci (GBS) sepsis and/or meningitis as well as discrepancies in dosing recommendations provided by pediatric reference sources. METHODS: Retrospective analysis of (pre)term infants treated with BPEN undergoing therapeutic drug monitoring (TDM) between May 2015 and May 2019. Outcomes included numbers of sub- and supratherapeutic concentrations, and dose adjustments, clinical evolution, and dosing recommendations from six pediatric reference sources. RESULTS: A total of 21 TDM samples from 8 neonates were evaluated. Among serum concentrations, 9/21 (43%) were below and 8/21 (38%) above the pre-specified therapeutic target range of 10-20 mg/L. Only 1 patient had BPEN determined in CSF whose concentration was below the lower limit of quantification. TDM identified a need for dose modification in 10/21 (48%) instances. Three of eight patients exhibited complete resolution of clinical, laboratory and radiologic signs of infection. Substantial variation in dosing recommendations (50,000-400,000 IE/kg/d) was present between reference sources. CONCLUSIONS: Our data reveal that under current dosage recommendations, the predefined target serum or CSF concentrations of BPEN are not achieved in all children. In case of clinical failure, serum and/or CSF BPEN concentrations should be determined. Given the wide variation in concentrations and subsequent dose requirements, further exploration of the clinical and pharmacologic characteristics of BPEN in (pre)term neonates is essential to optimize therapeutic efficacy.

First Danish case of infective endocarditis caused by Enterococcus hirae.

Enterococcus hirae, a member of the Enterococcus genus, is known to cause infections, including infective endocarditis (IE), in animal species. In humans, E. hirae is an uncommon pathogen, but has been associated with severe and recurrent disease. Here, we report the first Danish case of E. hirae native aortic valve IE in a 62-year-old woman with no history of heart disease. She presented to the hospital with symptoms of gastroenteritis but no signs of heart disease. Nevertheless, blood culture revealed growth of E. hirae, and a transoesophageal echocardiography demonstrated a mobile mass adherent to the aortic valve, compatible with a vegetation. The patient was successfully treated for E. hirae native aortic valve IE with 4 weeks of intravenous benzylpenicillin in combination with gentamicin for the initial 2 weeks. To the best of our knowledge, this is the first documented case of E. hirae IE in Denmark and the sixth documented case worldwide.

Lesiones orales como única manifestación de sífilis secundaria / Oral Lesions as the Only Manifestation of Secondary Syphilis

No disponible

Inflammation-Induced Attenuation of Prostaglandin D2 Elimination across Rat Blood-Brain Barrier: Involvement of the Downregulation of Organic Anion Transporter 3 and Multidrug Resistance-Associated Protein 4.

Prostaglandin (PG) D2 is a lipid mediator, and in the brain, overproduction of PGD2 is reportedly involved in the progression and exacerbation of neuroinflammation. The objective of this study was to elucidate PGD2 efflux transport, under normal and inflammatory conditions, across the blood-brain barrier (BBB), which is formed by brain capillaries. Elimination of [3H]PGD2 across the BBB of normal and lipopolysaccharide (LPS)-induced inflammatory rats was examined by the intracerebral microinjection technique. After intracerebral injection, the percentage of [3H]PGD2 remaining in the ipsilateral cerebrum decreased with time, with a half-life of 13 min. This [3H]PGD2 elimination across the BBB was significantly inhibited by the co-administration of unlabeled PGD2, which suggests carrier-mediated PGD2 efflux transport at the BBB. In isolated rat brain capillaries, mRNA expression of organic anion transporter (Oat) 3, organic anion-transporting polypeptide (Oatp) 1a4, and multidrug resistance-associated protein (Mrp) 4 was observed. In addition, co-administration of substrates/inhibitors for Oat3, Oatp1a4, and/or Mrp4, such as benzylpenicillin and cefmetazole, reduced [3H]PGD2 elimination across the BBB. Data suggest that Oat3 and Mrp4, but not Oatp1a4 are involved in PGD2 elimination across the BBB, as Oatp1a4-expressing Xenopus (X.) oocytes did not show the significant [3H]PGD2 uptake compared with water-injected X. oocytes. In LPS-treated rats, [3H]PGD2 elimination across the BBB and mRNA expression levels of Oat3 and Mrp4 were significantly decreased. Our data suggest that Oat3- and Mrp4-mediated PGD2 elimination across the BBB is attenuated under inflammatory conditions.

Neurocognitive disorder due to neurosyphilis: a case report. / Trastorno neurocognitivo debido a neurosífilis: informe de un caso.

INTRODUCTION: Neurosyphilis is a chronic infectious disease caused by Treponema pallidum that can cause a great variety of neuropsychiatric signs and symptoms, which complicates its diagnosis. CASE DESCRIPTION: This case occurred in a 40-year-old man who consulted the Emergency Department because of a convulsion (de novo) which was related to a chronic condition of cognitive impairment and psychosis. The appropriate studies were performed for the diagnosis of neurosyphilis and the recommended treatment was initiated. The patient presented clinical improvement and was discharged. DISCUSSION: Positive VDRL serology results and imaging findings of marked cortical atrophy conducted to consider a late-stage parenchymatous neurosyphilis with serious cognitive impairment and associated psychosis. Treatment with crystalline penicillin was formulated, which reduced the intensity of the patient's symptoms; however, the patient's lack of interest to attend the check-ups significantly reduces his chances of an adequate recovery. CONCLUSIONS: Neurosyphilis must be suspected in patients with clinically evident neurological or psychiatric symptoms. Analysis of VDRL serology and neuroimaging studies are important as an initial evaluation of the patient and must be complemented with cognitive tests or mental examination to determine the state of cognitive impairment.

Use of serum amyloid A in serum and synovial fluid to detect eradication of infection in experimental septic arthritis in horses.

While serum amyloid A (SAA) has been investigated as a potential marker for septic arthritis in horses, no study has reported on whether SAA can be used to detect eradication of joint infection. Therefore, the objective of this study was to investigate whether the eradication of joint infection in experimentally induced septic arthritis in horses can be detected using serum and synovial fluid SAA. A total of 17 horses were randomly assigned to 3 groups. A middle carpal joint of each horse was injected with saline (control group, n = 3), lipopolysaccharide (LPS) (nonseptic synovitis group, n = 6), or Escherichia coli (septic arthritis group, n = 8) on day 0. Starting on day 1, horses underwent treatment for septic arthritis. Sequential samples of serum and synovial fluid were collected, and quantification of SAA was carried out. Concentrations of serum and synovial fluid SAA were compared among groups and time points. A concurrent study was conducted and determined that infection was eradicated on day 4 in this experimental model of septic arthritis. Concentrations of serum and synovial fluid SAA rapidly increased after inoculation of E. coli and were highest on day 3 and day 4, respectively. Thereafter, both serum and synovial fluid SAA decreased with eradication of joint infection, although they remained significantly increased from baseline until day 9 and day 10, respectively. Serum and synovial fluid SAA did not increase in the control or nonseptic synovitis group. These findings suggest that serial measurements rather than a single measurement of SAA are required to determine eradication of infection from septic arthritis in horses.

Bien que l'amyloïde sérique (SAA) fut étudiée comme marqueur potentiel pour l'arthrite septique chez les chevaux, aucune étude n'a rapporté si SAA peut être utilisée pour détecter l'élimination d'une infection articulaire. Ainsi, l'objectif de la présente étude était d'examiner si l'élimination d'une infection articulaire lors d'arthrite septique induite expérimentalement chez les chevaux peut être détectée en utilisant la SAA du sérum et du liquide synovial. Un total de 17 chevaux fut réparti de manière aléatoire en trois groupes. Une articulation carpienne médiale de chaque cheval fut injectée avec de la saline (groupe témoin, n = 3), du lipopolysaccharide (LPS) (groupe synovite non-septique, n = 6) ou Escherichia coli (groupe arthrite septique, n = 8) au jour 0. En débutant au jour 1, les chevaux furent soumis à un traitement pour arthrite septique. Des échantillons séquentiels de sérum et de liquide synovial furent prélevés et la quantification de SAA effectuée. Les concentrations de SAA dans le sérum et le liquide synovial furent comparées parmi les groupes et à différents temps. Une étude concomitante était menée et a déterminé que l'infection était éliminée au jour 4 dans ce modèle expérimental d'arthrite septique. Les concentrations de SAA dans le sérum et le liquide synovial ont rapidement augmenté après l'inoculation d'E. coli et étaient maximales au jour 3 et au jour 4, respectivement. Par la suite, les concentrations de SAA du sérum et du liquide synovial ont diminué avec l'élimination de l'infection articulaire, bien qu'elles soient demeurées augmentées significativement par rapport au seuil de base jusqu'au jour 9 et jour 10, respectivement. Les concentrations de SAA du sérum et du liquide synovial n'ont pas augmenté dans les groupes témoin et synovite non-septique. Ces résultats suggèrent que des mesures en série plutôt qu'une mesure unique de SAA sont requises pour déterminer l'élimination de l'infection lors d'arthrite septique chez les chevaux.(Traduit par Docteur Serge Messier).

Recognizing and limiting syphilis to prevent congenital syphilis.

Syphilis is on the rise in every age and ethnicity group across the United States. The rate of congenital syphilis has started to rise as well, increasing the need for syphilis screening before pregnancy occurs. Raising awareness for syphilis screening, especially among sexually active women, is important, as the implications of this disease have lifelong effects for mother and child.

More than meets the eye: Papilledema from syphilis posing as idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a diagnosis of exclusion. Elevated intracranial pressure (ICP) can result from a variety of inflammatory and structural causes affecting cerebrospinal fluid production and absorption. First described in 1935, syphilis is a well-established cause of elevated ICP, referred to as syphilitic hydrocephalus. We report a case of a 49-year-old man presenting with vision changes and headache who was treated for IIH without resolution of symptoms, and eventually diagnosed with syphilitic hydrocephalus. Syphilis should be considered as a cause of elevated ICP prior to a diagnosis of IIH.

Syphilitic chorioretinitis presenting as a choroidal granuloma.

A rare case of syphilitic uveitis presenting as a choroidal granuloma is described in this case report. The clinical picture resembled that of a tubercular choroidal granuloma. However, the patient was positive for treponemal (treponema pallidum hemagglutination assay) as well as non-treponemal tests (venereal disease research laboratory test) for syphilis. Therefore, the patient was treated for ocular syphilis and responded to antisyphilitic therapy. There was a complete resolution of the lesion at the end of 14 days of treatment.

A Novel Way of Preventing Postoperative Pancreatic Fistula by Directly Injecting Profibrogenic Materials into the Pancreatic Parenchyma.

This paper aims to validate if intrapancreatic injection of penicillin G can enhance hardness and suture holding capacity (SHC) of the pancreas through prompting the fibrosis process. Soft pancreatic texture is constantly mentioned as one of the most contributory predictors of postoperative pancreatic fistula (POPF). Soft pancreas has poor SHC and higher incidence of parenchymal tearing, frequently leading to POPF. From a library of 114 antibiotic compounds, we identified that penicillin G substantially enhanced pancreatic hardness and SHC in experimental mice. Specifically, we injected penicillin G directly into the pancreas. On determined dates, we measured the pancreatic hardness and SHC, respectively, and performed molecular and histological examinations for estimation of the degree of fibrosis. The intrapancreatic injection of penicillin G activated human pancreatic stellate cells (HPSCs) to produce various fibrotic materials such as transforming growth factor-ß1 (TGF-ß1) and metalloproteinases-2. The pancreatic hardness and SHC were increased to the maximum at the second day after injection and then it gradually subsided demonstrating its reversibility. Pretreatment of mice with SB431542, an inhibitor of the TGF-ß1 receptor, before injecting penicillin G intrapancreatically, significantly abrogated the increase of both pancreatic hardness and SHC caused by penicillin G. This suggested that penicillin G promotes pancreatic fibrosis through the TGF-ß1 signaling pathway. Intrapancreatic injection of penicillin G promotes pancreatic hardness and SHC by enhancing pancreatic fibrosis. We thus think that penicillin G could be utilized to prevent and minimize POPF, after validating its actual effectiveness and safety by further studies.

Effect of benzylpenicillin on intravenous pharmacokinetics of acyclovir in red-eared slider turtles (Trachemys scripta elegans).

The aim of this study was to determine the effect of benzylpenicillin on the pharmacokinetics of acyclovir in red-eared slider turtles (Trachemys scripta elegans). Six clinically healthy red-eared slider turtles weighing 400 and 580 g were used for the study. Acyclovir (40 mg/kg) and benzylpenicillin (30 mg/kg) were administered intravenously to turtles. In the study, the cross-pharmacokinetic design (2 × 2) with a 30-day washout period was performed in two periods. Plasma concentrations of acyclovir were assayed using the high-performance liquid chromatography with fluorescence detection. Pharmacokinetic parameters were calculated by two-compartment open pharmacokinetic model. Following the administration of acyclovir alone, elimination half-life (t1/2 ß ), area under the plasma concentration-time curve (AUC), total clearance (ClT ), and volume of distribution at steady-state (Vdss ) were 20.12 hr, 1,372 hr * µg/mL, 0.03 L hr-1  kg-1 , and 0.84 L/kg, respectively. Benzylpenicillin administration increased t1/2 ß , AUC, and Vdss while decreased ClT of acyclovir. These results showed that benzylpenicillin changed the pharmacokinetics of acyclovir following simultaneous administration in turtles. However, further research is needed to determine molecular mechanism of interaction in turtle.