Syphilis / Congenital Syphilis

Aqueous crystalline penicillin G 100,000–150,000 units/kg/body weight/day, administered as 50,000 units/kg body weight/dose by IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days 

OR 

Procaine penicillin G 50,000 units/kg body weight/dose IM in a single daily dose for 10 days 

Aqueous crystalline penicillin G 100,000–150,000 units/kg body weight/day, administered as 50,000 units/kg body weight/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days 

OR 

Procaine penicillin G 50,000 units/kg body weight/dose IM in a single daily dose for 10 days 

OR 

Benzathine penicillin G 50,000 units/kg body weight/dose IM in a single dose 

Benzathine penicillin G 50,000 units/kg body weight/dose IM in a single dose* 

* Another approach involves not treating the newborn if follow-up is certain but providing close serologic follow-up every 2–3 months for 6 months for infants whose mothers’ nontreponemal titers decreased at least fourfold after therapy for early syphilis or remained stable for low-titer, latent syphilis (e.g., VDRL <1:2 or RPR <1:4). 

No treatment is required. However, any neonate with reactive nontreponemal tests should be followed serologically to ensure the nontreponemal test returns to negative. Benzathine penicillin G 50,000 units/kg body weight as a single IM injection might be considered, particularly if follow-up is uncertain and the neonate has a reactive nontreponemal test. 

Aqueous crystalline penicillin G 200,000–300,000 units/kg body weight/day IV, administered as 50,000 units/kg body weight every 4–6 hours for 10 days