Ana Fátima Braga Rocha1, Maria Alix Leite Araújo2, Melanie M Taylor3,4, Edna O Kara3, Nathalie Jeanne Nicole Broutet3. 1. University of Fortaleza-UNIFOR, Av. Washington Soares, 1321, Edson Queiroz, Fortaleza, Ceará, CEP 60.811-905, Brazil. ana_lumen@hotmail.com. 2. University of Fortaleza-UNIFOR, Av. Washington Soares, 1321, Edson Queiroz, Fortaleza, Ceará, CEP 60.811-905, Brazil. 3. World Health Organization, Department of Sexual Reproductive Health and Research, Geneva, Switzerland. 4. US Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention, Atlanta, GA, USA.
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. This study evaluated all live births in Fortaleza reported with CS in 2015 in order to identify the different therapeutic regimens used in newborns during this period of penicillin shortage. METHODS: A retrospective cross-sectional study design was conducted using manually extracted data from medical chart review of maternal and infant cases delivered in 2015 from all public maternity hospitals in the city of Fortaleza. Data collection occurred from June 2017 to July 2018. 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 serum VDRL titers ≥1:16 (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 reported 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.
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. This study evaluated all live births in Fortaleza reported with CS in 2015 in order to identify the different therapeutic regimens used in newborns during this period of penicillin shortage. METHODS: A retrospective cross-sectional study design was conducted using manually extracted data from medical chart review of maternal and infant cases delivered in 2015 from all public maternity hospitals in the city of Fortaleza. Data collection occurred from June 2017 to July 2018. 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 serum VDRL titers ≥1:16 (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 reported 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.
Authors: Stephen Nurse-Findlay; Melanie M Taylor; Margaret Savage; Maeve B Mello; Sanni Saliyou; Manuel Lavayen; Frederic Seghers; Michael L Campbell; Françoise Birgirimana; Leopold Ouedraogo; Morkor Newman Owiredu; Nancy Kidula; Lee Pyne-Mercier Journal: PLoS Med Date: 2017-12-27 Impact factor: 11.069
Authors: Melanie M Taylor; Stephen Nurse-Findlay; Xiulei Zhang; Lisa Hedman; Mary L Kamb; Nathalie Broutet; James Kiarie Journal: PLoS One Date: 2016-07-19 Impact factor: 3.240