Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults or adolescents with early syphilis
Intervention: Azithromycin
Comparison: Benzathine benzylpenicillin
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Serological cure | No statistically significant difference | Very low |
Clinical cure | Not estimable ᵃ | High |
Jarisch–Herxheimer reaction | No statistically significant difference | Low |
Nausea | No statistically significant difference | Low |
Vomiting <2 hours after administration | No statistically significant difference | Low |
Diarrhoea | No statistically significant difference | Low |
Serious adverse events (excluding deaths) | No statistically significant difference | Low |
Cutaneous (rash, fever) | No statistically significant difference | Low |
Administration-related (pain, fever) | Occurs more commonly with benzathine benzylpenicillin compared with azithromycin (favours intervention) | Low |
Central nervous system (dizziness, headache) | Occurs more commonly with azithromycin compared with benzathine benzylpenicillin (favours comparison) | Low |
Gastrointestinal (diarrhoea, nausea) | Occurs more commonly with azithromycin compared with benzathine benzylpenicillin (favours comparison) | Low |
Recommendations as stated in the source guideline When benzathine benzylpenicillin or procaine benzylpenicillin cannot be used (e.g., due to penicillin allergy) or are not available (e.g., due to stock-outs), the WHO STI guideline suggests using doxycyclineᵇ orally or ceftriaxoneᵇ intramuscularly, or, in special circumstances, azithromycinᵇ orally (conditional recommendation for very low-quality evidence).
Note Azithromycin is an option in special circumstances only when local susceptibility to azithromycin is likely. ᵃ The guideline states that all patients in both treatment and comparison groups were clinically cured. ᵇ See guideline for their recommendation on dose and duration of treatment for this drug.
This evidence table is related to the following section/s:
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