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. 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.<ref>O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.</ref> | 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.<ref>O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.</ref> | ||
;Shown below is a table summarizing the preferred and alternative empiric treatment for Donovanosis.<ref>http://www.cdc.gov/std/treatment/2006/genital-ulcers.htm#genulc4</ref> | ;Shown below is a table summarizing the preferred and alternative empiric treatment for Donovanosis.<ref>http://www.cdc.gov/std/treatment/2006/genital-ulcers.htm#genulc4</ref> | ||
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one double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 weeks and until all lesions have completely healed | one double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 weeks and until all lesions have completely healed | ||
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Therapy should be continued at least 3 weeks and until all lesions have completely healed. Some specialists recommend the addition of an aminoglycoside (e.g., gentamicin 1 mg/kg IV every 8 hours) to these regimens if improvement is not evident within the first few days of therapy. | Therapy should be continued at least 3 weeks and until all lesions have completely healed. Some specialists recommend the addition of an [[aminoglycoside]] (e.g., [[gentamicin]] 1 mg/kg IV every 8 hours) to these regimens if improvement is not evident within the first few days of therapy. | ||
===Management 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. However, the value of [[empiric therapy]] in the absence of clinical signs and symptoms has not been established. | |||
===Special Considerations=== | |||
====Pregnancy==== | |||
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 granuloma inguinale during pregnancy, but published data are lacking. [[Doxycycline]] and [[ciprofloxacin]] are contraindicated in pregnant women. | |||
====HIV Infection==== | |||
Persons with both granuloma inguinale and HIV infection should receive the same regimens as those who are [[HIV]] negative. Consideration should be given to the addition of a parenteral aminoglycoside (e.g., [[gentamicin]]). | |||
==References== | ==References== | ||
Revision as of 18:20, 30 November 2012
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Donovanosis Microchapters |
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Donovanosis medical therapy On the Web |
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Risk calculators and risk factors for Donovanosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
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]
- Shown below is a table summarizing the preferred and alternative empiric treatment for Donovanosis.[2]
| Pathogens | Preferred Treatment | Duration of Treatment | Alternative Treatment |
| Klebsiella granulomatis | Doxycycline
100 mg orally twice a day |
For at least 3 weeks and until all lesions have completely healed | Azithromycin
1 g orally once per week for at least 3 weeks and until all lesions have completely healed OR Ciprofloxacin 750 mg orally twice a day for at least 3 weeks and until all lesions have completely healed OR Erythromycin base 500 mg orally four times a day for at least 3 weeks and until all lesions have completely healed OR Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 weeks and until all lesions have completely healed |
Therapy should be continued at least 3 weeks and until all lesions have completely healed. Some specialists recommend the addition of an aminoglycoside (e.g., gentamicin 1 mg/kg IV every 8 hours) to these regimens if improvement is not evident within the first few days of therapy.
Management 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. However, the value of empiric therapy in the absence of clinical signs and symptoms has not been established.
Special Considerations
Pregnancy
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 granuloma inguinale during pregnancy, but published data are lacking. Doxycycline and ciprofloxacin are contraindicated in pregnant women.
HIV Infection
Persons with both granuloma inguinale and HIV infection should receive the same regimens as those who are HIV negative. Consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin).
References
- ↑ O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.
- ↑ http://www.cdc.gov/std/treatment/2006/genital-ulcers.htm#genulc4