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The appropriate dose and duration of penicillin for the treatment of neurosyphilis have not been established.Between 10%to 25%of patients with neurosyphilis fail to respond to low-dose penicillin regimens.This may be explained in part by the failure to achieve adequate penicillin levels. Treatment with benzathine penicillin,for example,has been shown to produce either nondetectable or nontreponemicidal levels of penicillin in the cerebrospinal fluid(CSF).In cases in which benzathine penicillin has failed,subsequent treatment with high-dose intravenous penicillin has successfully resolved the infection.This article describes a patient in whom all recommended forms of penicillin therapy and an experimental protocol of doxycycline therapy failed. |
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