University of Fortaleza-UNIFOR, Av. Washington Soares, 1321, Edson Queiroz, Fortaleza, Ceará, CEP 60.811-905, Brazil.
World Health Organization, Department of Sexual Reproductive Health and Research, Geneva, Switzerland.
BMC Pediatr. 2021 Apr 8;21(1):166. doi: 10.1186/s12887-021-02619-x.
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.
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.
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.
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.
2014 年至 2016 年期间，巴西经历了青霉素供应严重短缺，导致一些患有梅毒的孕妇和新生儿得不到治疗，并使用了没有证据支持的治疗方案。本研究评估了 2015 年在福塔莱萨报告的所有 CS 活产儿，以确定在青霉素短缺期间新生儿使用的不同治疗方案。
这是一项回顾性的横断面研究，使用从福塔莱萨市所有公立妇产医院的母婴病例病历中手动提取的数据进行研究。数据收集于 2017 年 6 月至 2018 年 7 月进行。
2015 年，福塔莱萨市共报告了 575 例先天性梅毒病例，其中 469 例（81.5%）进行了分析。其中，只有 210 例（44.8%）接受了国家推荐的治疗。作为替代治疗方案，头孢曲松用于 65 例（13.8%），头孢唑啉用于 15 例（3.2%），联合使用一种以上药物的有 179 例（38.2%）。血清 VDRL 滴度≥1:16（p=0.021）、出生时出现某些临床表现（p=0.003）、早产（p<0.001）、出生体重低（p=0.010）、有需要光疗的黄疸（p=0.019）和肝肿大（p=0.045）的新生儿更有可能根据国家治疗指南用青霉素治疗，而不是用其他方案治疗。
在福塔莱萨青霉素短缺期间，不到一半的 CS 报告婴儿接受了国家推荐的方案治疗，其余婴儿接受了分娩医院提供的药物治疗，包括不在国家或国际推荐治疗方案中的药物。
