Annals of Tropical Medicine and Public Health

EDITORIAL COMMENTARY
Year
: 2017  |  Volume : 10  |  Issue : 3  |  Page : 515--516

Anticipated shortage of benzathine penicillin: A threat to the ongoing global commitment for elimination of mother-to-child transmission of syphilis


Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy 
 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India

Correspondence Address:
Saurabh R Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India




How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Anticipated shortage of benzathine penicillin: A threat to the ongoing global commitment for elimination of mother-to-child transmission of syphilis.Ann Trop Med Public Health 2017;10:515-516


How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Anticipated shortage of benzathine penicillin: A threat to the ongoing global commitment for elimination of mother-to-child transmission of syphilis. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Oct 23 ];10:515-516
Available from: http://www.atmph.org/text.asp?2017/10/3/515/213165


Full Text

Globally, syphilis has been recognized as one of the major sexually transmitted infections accounting for 5.6 million cases each year, which also significantly enhances the risk of HIV acquisition.[1] As the infection can be transmitted from mother to infant during pregnancy, acquisition of infection during antenatal period is responsible for 0.3 million fetal and neonatal deaths every year and exposes another 0.2 million infants to the risk of death because of prematurity, low-birth-weight, stillbirths, or congenital deformities.[1]

Acknowledging the risk to both the mother and the infant with a definitive risk of long-term complications, the global stakeholders have aimed for the global elimination of mother-to-child transmission of congenital syphilis, and five nations have even successfully achieved it.[1],[2],[3] In order to cure the disease, it has been recommended to administer a single dose of benzathine penicillin early in the pregnancy, which not only will treat the mother, but even prevent or treat congenital syphilis in the fetus.[2]

Furthermore, the World Health Organization (WHO) has advocated for a single dose of benzathine penicillin for the infants' born to seropositive mother irrespective of whether the mother received treatment during pregnancy.[2]

Thus, penicillin is the preferred treatment of choice for achieving the aim of elimination of mother-to-child transmission of infection.[1],[2] However, a shortage of benzathine penicillin has been reported in three WHO regions, which is a serious concern, as infected women cannot avail it and hence a rise in the incidence of adverse health outcomes and congenital anomalies is anticipated.[4] These estimates are based on the number of infected pregnant women registered in 30 high-burden nations, and the findings suggest that there is a need of 0.7 million (50% to treat pregnant women and 50% to treat exposed infants in pediatric dosing) doses of benzathine penicillin, with a maximum need being in the African region.[5] Furthermore, it is extremely important to understand that the real need for the drug can be even higher as some of the infected patients remain asymptomatic and therefore remain undiagnosed.[4]

The WHO has laid three criteria, namely at least 95% of pregnant women should receive antenatal care, at least 95% of these pregnant women should be tested for syphilis during their pregnancy and at least 95% of the diagnosed pregnant women should avail adequate treatment, to ensure validation of elimination of congenital syphilis in any nation.[2],[3] As nations are gearing to achieve this elimination, the screening activity is expected to increase, and thus demand for penicillin will also increase in the coming days.[4] Furthermore, the recent estimates for maternal syphilis suggest that there has been a significant decline in the prevalence, and the entire credit goes to the timely administration of penicillin in adequate dosages in high-burden nations.[4],[5]

The current concern of shortage of the drug essentially requires increased awareness and vigilance to maintain a constant supply of the medicine.[5] Also, there is a need to promote production of drug, which can be easily corrected for the infants' weight and made available at an affordable price.[4] Moreover, the international welfare agencies have realized the importance of the issue and carefully assessing the trends of global supply and current and projected demand.[4] The manufacturers have also been instructed accordingly to meet the anticipated needs in the high-burden nations.[4],[5]

To conclude, in order to achieve the global target of mother-to-child elimination of syphilis and to prevent adverse outcomes among the infants, it is extremely important to ensure the availability and stable supply of benzathine penicillin across the world.

References

1World Health Organization. Sexually Transmitted Infections (STIs) —Fact Sheet N 110 2015;Available from: http://www.who.int/mediacentre/factsheets/fs110/en/. [Last accessed on 2016 Jul 13].
2World Health Organization Elimination of Mother-to-Child Transmission (EMTCT) of HIV and Syphilis —Global Guidance on Criteria and Processes for Validation. Geneva: WHO Press; 2014. pp. 1-24.
3World Health OrganizationWHO Validates Elimination of Mother-to-Child Transmission of HIV and Syphilis in Cuba. 2015. Available from: http://who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/. [Last accessed on 2016 Jul 17].
4World Health OrganizationNew Estimates Highlight Need for the Antibiotic That Can Cure Maternal and Congenital Syphilis Across World. 2016;Available from: http://who.int/reproductivehealth/topics/rtis/benzathine-penicillin/en/. [Last accessed on 2016 Jul 19].
5Taylor MM, Nurse-Findlay S, Zhang X, Hedman L, Kamb ML, Broutet N. et al. Estimating benzathine penicillin need for the treatment of pregnant women diagnosed with syphilis during antenatal care in high-morbidity countries. PLoS one 2016;11:e0159483.