A modified two-step treatment for actinomycetoma.
BACKGROUND
Combination antibiotic regimens are effective in the treatment of actinomycetoma but many treatment schedules require supervised parenteral therapy for prolonged periods. We describe a schedule that includes parenteral medication in an initial, short phase followed by a longer phase of oral medication.


METHODS
Sixteen patients with clinically diagnosed mycetoma, who did not show any evidence of a fungal etiology, were treated presumptively for actinomycetoma. Evidence of actinomycotic infection was found on microscopy of granules / discharge and / or histopathological examination in eight (50%) patients. The treatment consisted of an intensive phase (Step 1) with gentamicin, 80 mg twice daily, intravenously and cotrimoxazole, 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with cotrimoxazole and doxycycline, 100 mg twice daily till all sinuses healed completely. The treatment was continued for 5-6 months.


RESULTS
Treatment response was assessed monthly. At the end of the intensive phase, there was a significant improvement in all 16 patients. Nine patients who continued the maintenance phase of the regimen had complete healing of sinuses with marked reductions in swelling and induration in 2.4 +/- 1.7 months. Maintenance treatment was continued for a mean of 9.1 +/- 4.3 months in these patients. Six patients have remained free of disease activity during a follow-up period of 11.1 +/- 4.2 months after treatment was stopped. Two patients developed leucopenia and thrombocytopenia necessitating withdrawal of cotrimoxazole.


CONCLUSIONS
This regimen was effective in treating actinomycetoma. The short duration of the phase requiring parenteral therapy makes it convenient to administer.
Ramam
M
M
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. mramam@hotmail.com
Bhat
Radhakrishna
R
Garg
Taru
T
Sharma
Vinod K
VK
Ray
R
R
Singh
M K
MK
Banerjee
U
U
Rajendran
C
C
D000196:Actinomycosis / Q000188:drug therapy* / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004318:Doxycycline / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000188:drug therapy* / Q000382:microbiology; D017192:Skin Diseases, Bacterial / Q000382:microbiology / Q000473:pathology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage* / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline