zithromax and Urethral-Diseases

The efficacy of azithromycin as sole antimicrobial treatment for infection with Neisseria gonorrhoeae is reviewed. Aggregate cure rates for urethral and endocervical infection were 520/539 (96.5%; 95% CI 94.3% to 97.6%) for a 1 g dose from nine studies and 392/396 (99%; 95% CI 97.5% to 99.6%) for a 2 g dose from two studies. Azithromycin cured 46/47 (97.9%) cases of oropharyngeal infection and 34/35 (97.1%) cases of rectal infection evaluated within the clinical trials. Reports of in vitro resistance to azithromycin reveal a wide geographical spread of clinical isolates, with raised minimal inhibitory concentration to azithromycin and the emergence of high-level resistance in 2001. Concerns about resistance preclude azithromycin from general recommendation as sole antimicrobial therapy for gonorrhoea. However, azithromycin may have a valuable role in specific clinical situations and in combination with extended spectrum cephalosporins in the treatment of gonorrhoea.

Topics: Anti-Bacterial Agents; Azithromycin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Pharyngeal Diseases; Randomized Controlled Trials as Topic; Rectal Diseases; Treatment Outcome; Urethral Diseases; Uterine Cervical Diseases

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Humans; Levofloxacin; Male; Middle Aged; Nitrofurantoin; Urethra; Urethral Diseases; Young Adult

One hundred fifty-one female patients with acute urethral syndrome caused by Chlamydia trachomatis were examined. First, patients were divided into two groups, those with clinical symptoms present < 3 weeks before the start of treatment, and those with clinical symptoms > or = 3 weeks prior to the beginning of therapy. Then patients were further divided into groups and randomized to receive azithromycin once daily in a single dose of 1.0 g or 500 mg once daily for 6 days, or to receive doxycycline 100 mg b.i.d. for 14 days or 100 mg b.i.d. for 7 days (8 study groups in all). Clinical and bacteriological efficacy was evaluated 3 weeks after the end of therapy. In the group of patients with disease symptoms lasting for 3 weeks or longer, the eradication and clinical cure rates were significantly higher after administration of azithromycin in a dose of 1x500 mg/6 days than after a single dose of 1.0 g (p<0.01), and after administration of doxycycline 2x100 mg/14 days than by using doxycycline 2x100 mg/7 days (p<0.05).

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Dose-Response Relationship, Drug; Doxycycline; Drug Administration Schedule; Female; Humans; Middle Aged; Syndrome; Treatment Outcome; Urethral Diseases

One hundred ninety-two female patients with acute urethral syndrome caused by Ureaplasma urealyticum were examined. First, patients were divided into two groups: those with clinical symptoms present for less than 3 weeks before the start of treatment and those with clinical symptoms 3 weeks or longer before the beginning of therapy. The patients were then further divided into groups and randomized to receive azithromycin once daily in a single dose of 1 g or 500 mg once daily for 6 days, or to receive doxycycline 100 mg b.i.d. for 14 days or 100 mg b.i.d. for 7 days (eight study groups in all). Clinical and bacteriological efficacy were evaluated 3 weeks after the end of therapy. In the group of patients with disease symptoms lasting for 3 weeks or longer, eradication and clinical cure rates were significantly higher after the administration of azithromycin at a dose of 1 x 500 mg/6 days than after a single dose of 1 g (p < 0.001).

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Doxycycline; Female; Humans; Middle Aged; Syndrome; Time Factors; Treatment Outcome; Ureaplasma Infections; Ureaplasma urealyticum; Urethral Diseases

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Azithromycin; Doxycycline; Drug Administration Schedule; Female; Humans; Syndrome; Treatment Outcome; Ureaplasma Infections; Ureaplasma urealyticum; Urethral Diseases; Urinary Tract Infections

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Doxycycline; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Treatment Outcome; Ureaplasma Infections; Ureaplasma urealyticum; Urethral Diseases

Current lymphogranuloma venereum (LGV) guidelines mainly focus on anorectal infections. Inguinal LGV infections have been rare in the current epidemic among men who have sex with men (MSM), but might require a different approach not yet recommended in current guidelines for the treatment and diagnosis of LGV. We describe 4 inguinal LGV cases. Three MSM developed inguinal LGV infection several weeks after a previous consultation, of which two had received azithromycin after being notified for LGV. Three failed the recommended 21 days doxycycline treatment. These inguinal LGV cases highlight 3 pitfalls in the current standard management of LGV: (1) Urethral chlamydia infections in MSM can be caused by LGV biovars that in contrast to non-LGV biovars require prolonged antibiotic therapy. (2) The recommended one gram azithromycin contact treatment seems insufficient to prevent established infections. (3) Inguinal LGV may require prolonged courses of doxycycline, exceeding the currently advised 21 days regimen.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Dose-Response Relationship, Drug; Doxycycline; Hepatitis C; HIV Infections; Homosexuality, Male; Humans; Inguinal Canal; Lymphogranuloma Venereum; Male; Middle Aged; Treatment Failure; Urethral Diseases

Chlamydia trachomatis (C.t.) cell culture represents a sensitive method for the diagnosis of chlamydial infection and the only one which makes it possible to determine the susceptibility of an isolate to antibiotics so that an appropriate drug can be selected for individual treatment. In 11 patients, affected by urethroprostatitis and suspected of treatment failure with standard drug regimens, either due to lack of compliance with therapy or antibiotic resistance, C.t. was isolated in McCoy cell culture from urethral swabs, after prostatic massage. The in vitro activity of azithromycin against these isolates and the in vivo efficacy of the drug in the patients treated with a single 1 g dose have been evaluated. All the C.t. strains tested were susceptible to the action of azithromycin (MIC range 0.125-1.0 microgram/ml). Bactericidal values were one dilution higher (MBC range 0.25-2.0 microgram/ml). These in vitro results are consistent with clinical observations as all the patients treated had negative culture at a 4-week follow-up visit.

Topics: Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Humans; Male; Microbial Sensitivity Tests; Prostatitis; Urethral Diseases