Donovanosis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*A limited number of studies on Donovanosis treatment have been published. | |||
*A limited number of studies on Donovanosis treatment have been published. | *Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers. | ||
*Healing typically proceeds inward from the ulcer margins. | |||
*Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers. | *Relapse can occur 6–18 months after apparently effective therapy. | ||
*Healing typically proceeds inward from the ulcer margins. Relapse can occur 6–18 months after apparently effective therapy. | |||
*Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.<ref name="pmid12473810">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810 }} </ref> | *Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.<ref name="pmid12473810">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810 }} </ref> | ||
===Antimicrobial Therapy=== | ===Antimicrobial Therapy=== | ||
* | *Preferred regimen: [[Azithromycin]] 1 g PO once per week for at least 3 weeks and until all lesions have completely healed<ref name="CDC">2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/donovanosis.htm Accessed March 03 2016</ref> | ||
*Alternative regimen (1): [[Doxycycline]] 100 mg PO bid for at least 3 weeks and until all lesions have completely healed | |||
*Alternative regimen (2): [[Ciprofloxacin]] 750 mg PO bid for at least 3 weeks and until all lesions have completely healed | |||
*Alternative regimen (3): [[Erythromycin]] base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed | |||
*Alternative regimen (4): [[Trimethoprim-sulfamethoxazole]] one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed | |||
:*Note: The addition of an [[Aminoglycoside]] (e.g., [[Gentamicin]] 1 mg/kg IV q8h) to these regimens can be considered if improvement is not evident within the first few days of therapy. | |||
:* Note | ===Special Considerations=== | ||
*Doxycycline and ciprofloxacin are contraindicated among pregnant women. Pregnancy is a relative contraindication to the use of sulfonamides. Pregnant and lactating women should be treated with the erythromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin). Azithromycin might prove useful for treating donovanosis during pregnancy, but published data is lacking. | |||
*Individuals with both donovanosis and HIV infection should receive the same regimens as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered. | |||
===Follow-Up=== | ===Follow-Up=== | ||
Revision as of 14:56, 3 March 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
Antimicrobial therapy is indicated among patients with donovanosis. Medical therapy for donovanosis includes either oral doxycyline, azithromycin, ciprofloxacin, erythromycin, or trimethoprim-sulfamethoxazole for at least 3 weeks and until all lesions have completely healed. Sexual partners should also be evaluated and treated.
Medical Therapy
- A limited number of studies on Donovanosis treatment have been published.
- Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.
- Healing typically proceeds inward from the ulcer margins.
- Relapse can occur 6–18 months after apparently effective therapy.
- Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.[1]
Antimicrobial Therapy
- Preferred regimen: Azithromycin 1 g PO once per week for at least 3 weeks and until all lesions have completely healed[2]
- Alternative regimen (1): Doxycycline 100 mg PO bid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (4): Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed
- Note: The addition of an Aminoglycoside (e.g., Gentamicin 1 mg/kg IV q8h) to these regimens can be considered if improvement is not evident within the first few days of therapy.
Special Considerations
- Doxycycline and ciprofloxacin are contraindicated among pregnant women. Pregnancy is a relative contraindication to the use of sulfonamides. Pregnant and lactating women should be treated with the erythromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin). Azithromycin might prove useful for treating donovanosis during pregnancy, but published data is lacking.
- Individuals with both donovanosis and HIV infection should receive the same regimens as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered.
Follow-Up
Patients should be followed clinically until signs and symptoms resolve.[2]
Treatment of Sex Partners
Persons who have had sexual contact with a patient who has granuloma inguinale within the 60 days before onset of the patient’s symptoms should be examined and offered therapy.
- Note: the value of empiric therapy in the absence of clinical signs and symptoms has not been established.[2]
References
- ↑ O'Farrell N (2002). "Donovanosis". Sex Transm Infect. 78 (6): 452–7. PMC 1758360. PMID 12473810.
- ↑ 2.0 2.1 2.2 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/donovanosis.htm Accessed March 03 2016