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 


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


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


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


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  


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

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.