Irrational use of bicillin for the treatment of syphilis in Los Angeles
Doctors at a large non-profit clinic providing medical care to sexual minorities have used prolonged penicillins for the treatment of syphilis, which are not recommended for this purpose.
In March 2004, the Los Angeles Department of Health (United States) was informed of the use by physicians of a large not-for-profit clinic providing medical care to sexual minorities for the treatment of syphilis formulas. prolonged penicillin not recommended for this purpose. During the period January 1999 to March 2004, the infection was treated with bicillin CR, which is a combination of benzathine benzylpenicillin at a dose of 1.2 million units and procaine benzylpenicillin at a dose of 1.2 million units, instead of the recommended bicillin LA, containing 2.4 million units of benzathine benzylpenicillin.
The benzathine benzylpenicillin contained in the preparations ensures the maintenance of a stable high concentration of the antibiotic in the plasma over a long period of time, which determines the effectiveness of the treatment for syphilis. The use of bicillin C-R, containing half the recommended dose of benzathine benzylpenicillin, increases the risk of treatment failure and the development of neurosyphilis, especially in people infected with HIV.
The investigation revealed that the reason for the inadequate prescriptions was the receipt by the clinic instead of the bicillin LA ordered from a batch of bicillin CR, following which, from January 1999 to March 2004, this drug was the only one injectable penicillin available for doctors.
During the above-mentioned period, CR bicillin was prescribed to 429 patients (50% of whom were infected with HIV) for confirmed syphilis and 234 patients for preventive treatment. Attempts have been made to locate these individuals and to examine and reprocess them as indicated. In January 2005, 282 (66%) patients with a confirmed diagnosis of syphilis were contacted, 255 (59%) of them received a second treatment, 19 patients (4%) refused treatment. Of the 234 people who received preventive treatment, it was possible to contact 116 patients (50%); 98 of them were examined, 22 (22%) had a syphilitic infection, of which 19 people (19%) received adequate treatment and three (3%) refused treatment. In addition, inadequate infectious treatment could be one of the reasons for the increased incidence of syphilis in this region.
The above case is not the first, but the greatest fact of the improper use of penicillin drugs in the treatment of syphilis. In order to avoid such cases, the manufacturer agreed to make changes to the design of the outer packaging of bicillins C-R and L-A, highlighting the differences between the drugs. In addition, the inscription " not to be used for the treatment of syphilis" is printed on the packaging of bicillin C-R and on the bottle containing the medicine. A similar warning was issued in the drug annotation. Another measure proposed to reduce the incidence of inadequate antibiotic therapy is to provide training courses for doctors and pharmacists.