Jarisch Herxheimer reaction

• This is thought to be due to the release of endotoxins from ruptured spirochaetes in patients being treated for syphilis.

• The reaction can affect 50-80 per cent of patients.

• It starts 3-6 hours after administration of the initial dose of procaine ben-zylpenicillin. The reaction will usually resolve within 24 hours.

• Symptoms are flu-like and involve fevers, chills, sore throat, headache, malaise, exacerbation of lesions or outbreak of new lesions. Nausea, vomiting and arthralgia have also been reported.

• Patients should be counselled to take paracetamol for relief of symptoms and be reassured that the reaction is transient.


Cephalosporins are related to penicillins and also belong to the beta-lactam group of antibiotics. There is a 10 per cent cross-sensitivity in allergic patients. Over a hundred different types of cephalosporins are in existence. They are broadly similar, but can differ in bioavailabililty, pharmacokinetics and antibacterial activity.

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