Erythromycin versus tetracycline for treatment of Mediterranean spotted fever.

Muñoz-Espin, T; P, López-Parés; Espejo, Elena; Font-Creus, B; Martinez-Vila, I; Travería-Casanova, J; Segura-Porta, F; Bella, Feliu

doi:10.1136/adc.61.10.1027

Cited by 33 publications

(18 citation statements)

References 9 publications

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“…To our knowledge, this therapeutic regimen has not been used previously for children; however, the results we obtained with these shorter regimens are at least as good as those reported previously with a 10-day regimen (5 childhood [3]). So, we consider 1-day doxycyline to be the regimen of choice for children.…”

supporting

confidence: 61%

“…The potential usefulness of the new quinolone compounds has been recently reported (4,6), although quinolones should not be prescribed for pregnant women or for children. Erythromycin has poor in vitro antimicrobial activity against R. conorii (8) and has been shown to be less effective than tetracyclines for treating boutonneuse fever (5). In vitro evaluation of josamycin against Rickettsia rickettsii and R. conorii has shown that this macrolide antibiotic may be of clinical use in treating spotted fever rickettsiosis (7).…”

mentioning

confidence: 99%

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Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever

Bella

Font

Úriz

et al. 1990

Antimicrob Agents Chemother

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We undertook a randomized clinical trial comparing therapeutic efficacy of the 1-day doxycycline regimen with the 5-day josamycin regimen for Mediterranean spotted fever. All 59 patients recovered uneventfully, and results did not significantly differ between the two schedules. One-day doxycycline therapy is an effective, easy, and inexpensive treatment. Josamycin is a useful therapeutic alternative that may be particularly convenient for pregnant women and patients with a history of allergy to tetracyclines.

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supporting

confidence: 61%

mentioning

confidence: 99%

Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever

Bella

Font

Úriz

et al. 1990

Antimicrob Agents Chemother

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“…Erythromycin was prescribed by Miller and Gear (24) for patients with South African tick fever; two of these patients failed to respond to the treatment. Munoz Espin et al (27) randomly compared erythromycin with doxycycline in children and observed failures and delayed apyrexia with erythromycin. The same team recently compared josamycin with doxycycline and concluded that josamycin is effective (3).…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial therapy of rickettsial diseases

Raoult¹,

Drancourt²

1991

Antimicrob Agents Chemother

137

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“…Erythromycin is not active against R. conorii in vitro or in vivo (31). Roxithromycin is active in vitro and has pharmacokinetic advantages but failed in a clinical study (32).…”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Clarithromycin for Mediterranean Spotted Fever

Antón

Muñoz

Travería

et al. 2016

Antimicrob Agents Chemother

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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. Mediterranean spotted fever (MSF) is a spotted fever group rickettsiosis. Caused by Rickettsia conorii, MSF is endemic in the Mediterranean area. Clinically, MSF is characterized by fever, exanthema, and the inoculation eschar known as tache noire. MSF affects people of both sexes and all ages (1-3).Antibiotic therapy helps prevent progression to severe disease and the associated mortality (4). Classic antibiotic therapy consists of tetracyclines or chloramphenicol, although the use of chloramphenicol in developed countries is limited by its bone marrow toxicity (5).Both in vitro and in vivo studies have shown that doxycycline is highly efficacious in this group of rickettsiosis. Even short-course treatments with doxycycline are highly effective (6). Nevertheless, it would be useful to have alternative treatments for patients allergic to tetracyclines, pregnant women, and children Ͻ8 years old.In vitro studies have shown that rifampin, the fluoroquinolones, and some macrolides have good activity against R. conorii (7, 8); however, of these, only josamycin has proven efficacy in vivo (9). Although josamycin has been commercially available for years in some countries (e.g., France, Switzerland, Austria, Italy, South Africa, and Spain), it is unavailable in many others. Thus, it would be useful to have another antibiotic that can be obtained in most countries to treat MSF.Several studies showed that clarithromycin and its metabolite 14-hydroxyclarithromycin have excellent in vitro activity against R. conorii and Rickettsia rickettsii (10-12), and these results were confirmed in clinical studies, where clarithromycin was efficacious and safe in treating children with spotted fever group...

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Erythromycin versus tetracycline for treatment of Mediterranean spotted fever.

Cited by 33 publications

References 9 publications

Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever

Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever

Antimicrobial therapy of rickettsial diseases

Randomized Trial of Clarithromycin for Mediterranean Spotted Fever

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