trimethoprim--sulfamethoxazole-drug-combination and Chlamydia-Infections

Antibiotics are one of four arms of the SAFE strategy for the control of trachoma, an eye infection that is responsible for more cases of blindness than any condition other than cataract. The evidence for the use of topical tetracycline and oral tetracycline, doxycycline, erythromycin, cotrimoxazole and azithromycin in trachoma are reviewed here and a number of issues are nominated as research and policy priorities.

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Chlamydia Infections; Chlamydia trachomatis; Conjunctivitis, Inclusion; Doxycycline; Drug Therapy, Combination; Erythromycin; Humans; Ophthalmic Solutions; Randomized Controlled Trials as Topic; Tetracycline; Trachoma; Trimethoprim, Sulfamethoxazole Drug Combination

Each of 201 men with symptoms and signs of acute urethritis was randomly assigned to one of two treatment regimens: ampicillin (2g) plus probenecid (1g), or sulphamethoxazole-trimethoprim (SMX-TMP) (sulphamethoxazole 1600 mg plus trimethoprim 320 mg) four tablets twice daily for two days. Before treatment Neisseria gonorrhoeae was isolated from 162 patients, while coexistent Chlamydia trachomatis was recovered from 42 (26%) men. After treatment N gonorrhoeae persisted in 11 (14.3%) of the 77 patients treated with ampicillin and probenecid and in three (3.5%) of the 85 treated with SMX-TMP (p less than 0.05), while C trachomatis persisted in four (16%) of the 25 men treated with SMX-TMP and in all 17 patients treated with ampicillin and probenecid. SMX-TMP was thus more effective than ampicillin in treating acute gonorrhoea in men and in eradicating concurrent C trachomatis infection.

Topics: Acute Disease; Ampicillin; Anti-Infective Agents, Urinary; Chlamydia Infections; Chlamydia trachomatis; Clinical Trials as Topic; Drug Combinations; Drug Therapy, Combination; Gonorrhea; Humans; Male; Probenecid; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

The World Health Organization has proposed the syndromic approach for management of sexually transmissible diseases (STD) in countries where diagnostic laboratory tests are not consistently available. The purpose of this study was to evaluate the effectiveness of this approach for treatment of ureteral discharge in Senegal. Twenty seven men presenting ureteral discharge underwent two-week treatment using a combination of cotrimoxazole plus tetracycline for suspected gonococcal and a chlamydial infections. Ureteral samples were collected before and after treatment to detect Neisseria gonorrhoeae by culture and Chlamydia trachomatis by direct immunofluorescence and ELISA. Results demonstrated successful treatment of all patients presenting gonococcal and chlamydial infections i.e. 84.6% of cases. Neither germ was detected in 15.4% of cases. Before treatment, Neisseria gonorrhoeae, Chlamydia trachomatis or both were found respectively in 53.9%, 5.1% and 25.6% of samples respectively. Based on these findings we conclude that the syndromic approach was effective in 84.6% of cases but treatment was in adequation with STD biologically documented only with 25.6% of cases.

Topics: Anti-Bacterial Agents; Chlamydia Infections; Chlamydia trachomatis; Drug Therapy, Combination; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Senegal; Syndrome; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Urethral Diseases

Acute prostatitis usually is caused by aerobic gram-negative organisms or, to a lesser extent, the enterococci. The treatment of acute prostatitis requires the use of an antimicrobial with the appropriate spectrum for ten to fourteen days. However, treatment of chronic prostatitis is a more difficult therapeutic problem because of the relative impermeability of the noninflamed prostate to the majority of antimicrobial agents. The organisms most commonly responsible for chronic prostatitis include the aerobic gram-negative organisms, as well as chlamydia. Chlamydia may be the sole pathogens, or may be found as a copathogen with gram-negative organisms. Relatively few antibiotics have the appropriate physiochemical characteristics to penetrate the subacutely inflamed prostate. The most important determinant of tissue penetration in chronic prostatitis is the lipid solubility of the antibiotic, to a lesser extent its pKa (ionization potential), and the molecular size of the antibiotic. In general, penicillins, cephalosporins, and aminoglycosides do not penetrate well into the chronically inflammed prostate tissue. At the present time, the preferred agents in treating chronic prostatitis are trimethoprim or doxycycline. Doxycycline has the advantage of being active against chlamydia as well as the usual organisms that are responsible for chronic prostatitis. Therapy should be continued for two to three months.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Chlamydia Infections; Drug Combinations; Enterobacteriaceae Infections; Erythromycin; Humans; Hydrogen-Ion Concentration; Leucomycins; Male; Penicillins; Prostatitis; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination