title: Randomized Trial of Clarithromycin for Mediterranean Spotted Fever.
abstract: The classic antibiotic treatment for Mediterranean spotted fever (MSF) is based on tetracyclines or chloramphenicol, but chloramphenicol's bone marrow toxicity makes tetracyclines the treatment of choice. However, it is convenient to have alternatives available for patients who are allergic to tetracyclines, pregnant women, and children <8 years old. We conducted a randomized clinical trial to compare clarithromycin with doxycycline or josamycin in the treatment of MSF. Forty patients were evaluated (23 male; mean age, 39.87 years); 13 patients were aged <14 years. Seventeen patients received clarithromycin, and 23 received doxycycline or josamycin. The interval between the onset of symptoms and the start of treatment was 4.04 ± 1.70 days in the clarithromycin group versus 4.11 ± 1.60 days in the doxycycline/josamycin group (P = not significant [NS]). Time to the disappearance of fever after treatment was 2.67 ± 1.55 days in the clarithromycin group versus 2.22 ± 1.35 days in the doxycycline/josamycin (P = NS). The symptoms had disappeared at 4.70 ± 2.25 days in the clarithromycin group versus at 4.75 ± 3.08 days in the doxycycline/josamycin (P = NS). There were no adverse reactions to treatment or relapses in either group. In conclusion, clarithromycin is a good alternative to doxycycline or josamycin in the treatment of MSF.
authors.affiliation: Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain eanton@tauli.cat.
authors.forename: Esperança
authors.initials: E
authors.lastname: Anton
authors.affiliation: Department of Pediatric Medicine, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: Tomas
authors.initials: T
authors.lastname: Muñoz
authors.affiliation: Department of Pediatric Medicine, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Travería
authors.affiliation: Universitat Autònoma de Barcelona, Barcelona, Spain Department of Epidemiology, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Navarro
authors.affiliation: Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: Bernat
authors.initials: B
authors.lastname: Font
authors.affiliation: Universitat Autònoma de Barcelona, Barcelona, Spain Department of Microbiology, UDIAT-CD, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sanfeliu
authors.affiliation: Department of Infectious Diseases, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Segura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001907:Boutonneuse Fever / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D015570:Josamycin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020114:Rickettsia conorii / Q000187:drug effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin; D015570:Josamycin; D004318:Doxycycline