Comparative evaluation of long-term ophthalmic sequelae following first versus second-line antibiotic treatment for congenital syphilis.

Purpose: Congenital syphilis (CS) is associated with interstitial keratitis, chorioretinitis, uveitis, and optic atrophy mainly in inadequately treated patients. We conducted a retrospective cohort analysis evaluating ocular findings in children born in 2015 with CS treated with ceftriaxone at the time of delivery during the period of penicillin shortage in a city located at Northeast of Brazil and compared them with those adequately treated.

Methods: 469 children were reported with CS at birth during the penicillin shortage period and 171 were actively searched and invited to an ophthalmological assessment and retrospective analysis of their information recorded in the medical records of the municipality's health services.

Results: A total of 68 children came to the assessment, median age 8 years of age (range 7-8 years), 48 were treated with penicillin (70.5%) and 20 with ceftriaxone (29.5%). There were no significant differences in demographic or perinatal characteristics between the groups. The majority of children had a completely normal ophthalmological examination (67.6%). Regarding findings that are more associated with CS, one child in ceftriaxone group (5.0%) had optic atrophy in one eye and one in the penicillin group (2.9%) had glaucomatous optic disc changes. No interstitial keratitis was found. There was no significant association between the child's treatment and the prevalence of ophthalmologic findings (p = 0.663). There was also no association between the medication and a current reactive VDRL (p = 1.000).

Conclusion: After an 8-year follow-up, no statistically significant difference was observed in the incidence of ophthalmologic manifestations among individuals treated for CS with either penicillin or ceftriaxone. These findings suggest that ceftriaxone may serve as an effective alternative for the prevention of CS and its associated ocular complications.