Bacteremia due to Dietzia maris in an immunocompromised patient.

Despite few data to guide practice, no well-stated clinical guidelines, and the lack of approval by the US Federal Drug Administration for the practice, nearly 1 of every 5 physicians surveyed here used ceftriaxone for the treatment of early-stage syphilis. The physicians queried were by definition specialists in infectious diseases; therefore, this response may overestimate national practice. Nonetheless, it cannot be ignored, particularly since specialists often initiate practices that are eventually adopted by generalists. It is curious that so many clinicians chose to use ceftriaxone, because patients requiring therapy had or were suspected to have penicillin allergy. Allergic cross-reactions between blactam antibiotics can occur. It is estimated that 3%–7% of patients with a history of penicillin allergy may have reactions to cephalosporins [9]. Ceftriaxone might justifiably be considered a useful alternative to penicillin for the penicillin-allergic pregnant patient, for whom alternatives do not exist. Unfortunately, the few studies of ceftriaxone for the treatment of syphilis that have been conducted thus far did not include pregnant women, and its use for this population cannot be recommended. The search for alternatives to penicillin is warranted, although declining rates of syphilis may make this a difficult task [10]. Ideally, ceftriaxone should be examined if only because so many clinicians are choosing to use it.