Donovanosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Antimicrobial therapy is indicated | 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== | ==Medical Therapy== | ||
*All patients with donovanosis and their sexual partners (within 60 days) should be evaluated and treated with antimicrobial therapy.<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459 }} </ref> | |||
*A limited number of studies on Donovanosis treatment have been published.<ref>O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.</ref> | |||
*Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.<ref>O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.</ref> | |||
*Healing typically proceeds inward from the ulcer margins. Relapse can occur 6–18 months after apparently effective therapy.<ref>O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.</ref> | |||
*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> | |||
=== | ===Antimicrobial Therapy=== | ||
* '''Donovanosis'''<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459 }} </ref> | |||
:*Preferred regimen: [[Doxycycline]] 100 mg PO bid for at least 3 weeks and until all lesions have completely healed | |||
:*Alternative regimen (1): [[Azithromycin]] 1 g PO once per week for at least 3 weeks and until all lesions have completely healed | |||
Pregnancy is a relative contraindication to the use of | :*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 (1): 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 (2): Patients should be followed clinically until signs and symptoms have resolved. | |||
* Note (3): Individuals who have had sexual contact with a patient diagnosed with donovanosis within the past 60 days prior to the onset of the patient's symptoms should also be examined and offered therapy. However, the value of empiric therapy in the absence of clinical signs and symptoms has not been established. | |||
* Note (4): 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. | |||
* Note (5): 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. | |||
==References== | ==References== | ||
Revision as of 01:07, 4 October 2015
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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
- All patients with donovanosis and their sexual partners (within 60 days) should be evaluated and treated with antimicrobial therapy.[1]
- A limited number of studies on Donovanosis treatment have been published.[2]
- Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.[3]
- Healing typically proceeds inward from the ulcer margins. Relapse can occur 6–18 months after apparently effective therapy.[4]
- Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.[5]
Antimicrobial Therapy
- Donovanosis[1]
- Preferred regimen: Doxycycline 100 mg PO bid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (1): Azithromycin 1 g PO once per week 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 (1): 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 (2): Patients should be followed clinically until signs and symptoms have resolved.
- Note (3): Individuals who have had sexual contact with a patient diagnosed with donovanosis within the past 60 days prior to the onset of the patient's symptoms should also be examined and offered therapy. However, the value of empiric therapy in the absence of clinical signs and symptoms has not been established.
- Note (4): 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.
- Note (5): 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.
References
- ↑ 1.0 1.1 Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
- ↑ O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.
- ↑ O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.
- ↑ O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.
- ↑ O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.