Prednisolone in Neurosyphillis

UK national guidelines on the management of syphilis 2015	Steroids should be given with all anti-treponemal antibiotics for cardiovascular syphilis; 40–60 mg prednisolone OD for three days starting 24 h before the antibiotics.
Syphilis: diagnosis and management options [The Pharmaceutical Journal, 20 Mac 2018]	Steroids should be given with all treatment regimens for late syphilis with cardiovascular or neurological involvement; 40–60mg prednisolone OD for three days starting 24 hours before antibiotics
https://www.bashhguidelines.org/current-guidelines/genital-ulceration/syphilis-2015/	Steroids should be given with all anti-treponemal antibiotics for neurosyphilis; 40–60mg prednisolone OD for three days starting 24h before the antibiotics.
2014 European Guideline on the Management of Syphilis	• Prednisolone can prevent the febrile episode Although steroids are unproven at ameliorating local infection, biological plausibility suggests that those may help preventing severe deterioration in early syphilis with optic neuritis and uveitis. • Management: - If cardiovascular or neurological involvement (including optic neuritis) exists, inpatient management is advisable. - Prevention of Jarisch-Herxheimer reaction: Prednisolone 20-60 mg daily for 3 days, starting anti-treponemal treatment after 24 hours of commencing prednisolone [IV; C] - Antipyretics
https://www.medscape.com/answers/1169231-113753/how-is-a-jarisch-herxheimer-reaction-to-neurosyphilis-therapy-managed [Updated 17 July 2018]	Corticosteroids (eg, prednisone at 20 mg 4 times per day for 3 d started 1 d prior to antitreponemal treatment) have been used to prevent adverse effects. Salicylates/antipyretics are prescribed for symptomatic relief.
National Antibiotic Guideline (Malaysia) 2014	All patients with neurosyphilis should be considered for corticosteroid cover at the start of the therapy to prevent the Jarisch-Herxheimer reaction (Prednisolone 10-20mg PO q8h for 3 days commencing one day prior to syphilis treatment)

All accessed on 22 Aug 2019 by JCK Ho