Failure of treatment for chancroid in Rwanda is not related to human immunodeficiency virus infection: in vitro resistance of Haemophilus ducreyi to trimethoprim-sulfamethoxazole.
A comparative open study was performed to evaluate the efficacy of single doses of ciprofloxacin (500 mg) and trimethoprim-sulfamethoxazole (TMP-SMZ; 640 mg/3,200 mg) for the treatment of culture-proven chancroid. Clinical cure or improvement was observed 7 days after treatment in 32 (76.2%) of the 42 patients who received ciprofloxacin and 21 (52.5%) of the 40 patients who received TMP-SMZ (P = .04). Cultures for one (4.5%) of 22 patients not cured with ciprofloxacin and 16 (59.3%) of 27 patients not cured with TMP-SMZ were still positive for Haemophilus ducreyi 7 days after treatment (P < .001). Although 77 (71.3%) of the 108 patients tested were seropositive for HIV-1 antibody, HIV infection and the degree of CD4+ lymphocyte depletion had no effect on clinical and bacteriologic outcome. All isolates of H. ducreyi were highly susceptible to ciprofloxacin (MIC, 0.004-0.06 mg/L). In contrast, resistance to TMP-SMZ (MIC, > or = 4/76 micrograms/mL) was observed in 48.9% of isolates (22 of 45) and was significantly associated with treatment failure. Therefore, the administration of TMP-SMZ, in single or multiple doses, is no longer indicated for the treatment of chancroid in Rwanda.
Bogaerts
J
J
Laboratory of Microbiology (Centre Hospitalier de Kigali), Belgo-Rwandan Medical Cooperation.
Kestens
L
L
Martinez Tello
W
W
Akingeneye
J
J
Mukantabana
V
V
Verhaegen
J
J
Van Dyck
E
E
Piot
P
P
D000328:Adult; D018791:CD4 Lymphocyte Count; D002602:Chancroid / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications; D006191:Haemophilus ducreyi / Q000187:drug effects*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012432:Rwanda; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use*
D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination