Congenital Syphilis

Patient Population:
Pediatric
Condition Major Pathogens  First-choice Therapy Alternative Therapy Comments

Syphilis (congenital) 

Refer to CDPH algorithm for guidance on interpretation of infant risk and recommended evaluation 

Treponema pallidum 

Full treatment course (as indicated per algorithm)

Preterm infant (<=36 weeks GA): Refer to neonatal dosing guidelines for penicillin interval adjustments 

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Age <=7d:
Penicillin G 50,000 units/kg/dose IV q12h 

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Age 8 days to <1 month:
Penicillin G 50,000  units/kg/dose IV q8h 

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Age >=1 month:
Penicillin G 50,000 units/kg/dose IV q4-6 hours  

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Single dose - only use in selected infants as indicated per algorithm: Benzathine penicillin 50,000 units/kg IM x 1 dose 

 

Consider ID consult 

Duration (IV): 10 days 

Penicillin treatment should be continued without interruption; if > 1 day of treatment is missed, the entire course should be resumed and continued for the full duration from time of re-initiation  

References:  

American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.  

California Department of Public Health: Congenital Syphilis Resources for Providers