Donovanosis medical therapy: Difference between revisions
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{{Donovanosis}} | {{Donovanosis}} | ||
{{CMG}} {{AE}} {{KD}} | {{CMG}} {{AE}} {{KD}} | ||
==Overview== | |||
Antimicrobial therapy is indicated in granuloma inguinale. Although several antimicrobial regimens have been effective, there are a limited number of published studies on the treatment of Donovaniosis. [[Azithromycin]] is the drug of choice. Alternative regimens include either [[Doxycycline]], [[Ciprofloxacin]], [[Erythromycin]], or [[TMP-SMX]]. Patients who are pregnant must be treated with [[Erythromycin]]. | |||
==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> | ||
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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., [[ | 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=== | ===Management of Sex Partners=== | ||
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===Special Considerations=== | ===Special Considerations=== | ||
====Pregnancy==== | ====Pregnancy==== | ||
Pregnancy is a relative contraindication to the use of [[sulfonamides]]. [[Pregnant]] and lactating women should be treated with the [[ | 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==== | ====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., [[ | 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]]).<ref name="Workowski-2010">{{Cite journal | last1 = Workowski | first1 = KA. | last2 = Berman | first2 = S. | last3 = Workowski | first3 = KA. | last4 = Bauer | first4 = H. | last5 = Bachman | first5 = L. | last6 = Burstein | first6 = G. | last7 = Eckert | first7 = L. | last8 = Geisler | first8 = WM. | last9 = Ghanem | first9 = K. | title = Sexually transmitted diseases treatment guidelines, 2010. | journal = MMWR Recomm Rep | volume = 59 | issue = RR-12 | pages = 1-110 | month = Dec | year = 2010 | doi = | PMID = 21160459 }}</ref> | ||
==References== | ==References== | ||
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[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 14:28, 17 August 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 in granuloma inguinale. Although several antimicrobial regimens have been effective, there are a limited number of published studies on the treatment of Donovaniosis. Azithromycin is the drug of choice. Alternative regimens include either Doxycycline, Ciprofloxacin, Erythromycin, or TMP-SMX. Patients who are pregnant must be treated with Erythromycin.
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.
Anti microbial regimen
- 1.Granuloma Inguinale (Donovanosis)[2]
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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
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).[3]
References
- ↑ O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.
- ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
- ↑ Workowski, KA.; Berman, S.; Workowski, KA.; Bauer, H.; Bachman, L.; Burstein, G.; Eckert, L.; Geisler, WM.; Ghanem, K. (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459. Unknown parameter
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