A two-step schedule for the treatment of actinomycotic mycetomas.
Actinomycotic mycetomas usually respond slowly to treatment with antibiotics. In an attempt to hasten clinical resolution, we used a 2-step regimen consisting of an intensive phase of therapy with penicillin, gentamycin and co-trimoxazole for 5-7 weeks, followed by maintenance therapy with amoxicillin and co-trimoxazole. Seven patients were treated, all of whom showed significant reduction in discharge and swelling after the intensive phase. Maintenance therapy was continued for 2-5 months after the lesions became completely inactive. Five patients completed maintenance therapy, which was given for 6-16 months (mean 10.7 months), and remained free of disease during a mean post-treatment follow-up period of 6.4 months. The other 2 patients also responded satisfactorily and continue to receive maintenance therapy. Side-effects necessitating a modification of the treatment schedule occurred in 2 patients but reversed on discontinuation of the drugs responsible. This treatment schedule produces a rapid clinical response during the initial, intensive phase and promotes compliance with the longer maintenance phase of treatment necessary to achieve a complete cure.
Ramam
M
M
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi. mramam@hotmail.com
Garg
T
T
D'Souza
P
P
Verma
K K
KK
Khaitan
B K
BK
Singh
M K
MK
Banerjee
U
U
D000196:Actinomycosis / Q000175:diagnosis / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy*; D010406:Penicillins / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D005839:Gentamicins; D010406:Penicillins; D000658:Amoxicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination