Document 0205
 DOCN  M95A0205
 TI    Failure of treatment for chancroid in Rwanda is not related to human
       immunodeficiency virus infection: in vitro resistance of Haemophilus
       ducreyi to trimethoprim-sulfamethoxazole.
 DT    9510
 AU    Bogaerts J; Kestens L; Martinez Tello W; Akingeneye J; Mukantabana V;
       Verhaegen J; Van Dyck E; Piot P; Laboratory of Microbiology (Centre
       Hospitalier de Kigali),; Belgo-Rwandan Medical Cooperation.
 SO    Clin Infect Dis. 1995 Apr;20(4):924-30. Unique Identifier : AIDSLINE
       MED/95315399
 AB    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.
 DE    Adult  Chancroid/BLOOD/COMPLICATIONS/*DRUG THERAPY
       Ciprofloxacin/PHARMACOLOGY/*THERAPEUTIC USE  Comparative Study  CD4
       Lymphocyte Count  Drug Resistance, Microbial  Female  Follow-Up Studies
       Haemophilus ducreyi/*DRUG EFFECTS  Human  HIV Infections/COMPLICATIONS
       Male  Microbial Sensitivity Tests  Rwanda  Treatment Failure
       Trimethoprim-Sulfamethoxazole Combination/PHARMACOLOGY/  *THERAPEUTIC
       USE  CLINICAL TRIAL  JOURNAL ARTICLE

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