A 45-year-old man is diagnosed with symptomatic neurosyphilis (meningovascular involvement). CSF VDRL is reactive. Which regimen is recommended?

• A Benzathine penicillin 2.4 million units IM weekly for 3 weeks
• B Azithromycin 2 g single oral dose
• C Doxycycline 100 mg twice daily for 28 days
• D Aqueous crystalline penicillin G 18 to 24 million units per day IV for 10 to 14 days ✓

Explanation

Neurosyphilis requires high-dose intravenous aqueous crystalline penicillin G, 18 to 24 million units daily in divided doses for 10 to 14 days, to achieve treponemicidal levels in CSF. Benzathine penicillin does not reach adequate CSF concentrations, so it is inadequate despite being standard for primary and secondary syphilis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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