Evaluation of 500- and 1,000-mg doses of ciprofloxacin for the treatment of chancroid

Abstract

A randomized, double-blind study was performed comparing ciprofloxacin in a 500-mg single dose with 1,000 mg (500-mg doses given 12 h apart) for the treatment of chancroid in Thailand. Haemophilus ducreyi was isolated from 87 (48%) of 180 men with a clinical diagnosis of chancroid. For men with ulcers that were culture positive for H. ducreyi, rates of cure were 100% in the 500-mg group and 98% in the 1,000-mg group. For men with ulcers that were culture negative for H. ducreyi, rates of cure were 93% in the 500-mg group and 96% in the 1,000-mg group. The MIC of ciprofloxacin for 50% of isolates among 85 isolates of H. ducreyi was 0.007 ,ug/ml (range, 0.002 to 0.03 ,ig/ml). No significant adverse effects were detected in either group. These data indicate that both of these treatment regimens are equally effective therapies for chancroid in Thailand.Chancroid, caused by Haemophilus ducreyi, is the major cause of genital ulcer disease in developing countries and is becoming an increasingly important sexually transmitted disease in the United States (9). In Thailand, chancroid infections account for nearly 20% of the venereal disease in men (11). At present the only drug that can be given orally is erythromycin, but erythromycin must be given at least for 7 days, a regimen that is associated with poor therapeutic compliance (2,4,8). Trimethoprim-sulfamethoxazole even when given in a standard 7-day regimen is frequently not an effective treatment for chancroid in Thailand (12). A single 250-mg dose of ceftriaxone is also effective, but it must be given parenterally (12). Thus, there is a need for a shortcourse or single-dose oral regimen for the treatment of chancroid. Ciprofloxacin, a new quinolone antimicrobial agent, is very effective against H. ducreyi in vitro (10), and a single oral dose is also effective for the treatment of gonorrhea. Ciprofloxacin was an efficacious and well-tolerated treatment of chancroid with a single dose (500 mg) and a 3-day regimen (500 mg twice daily) in Africa (6, 7). In the current study, we compared two regimens of ciprofloxacin, 500 mg (one tablet) and 1,000 mg (two tablets), for the treatment of chancroid in Thailand. MATERIALS AND METHODSPatients and study design. From August 1986 to January 1987, 200 men who came to the Bangrak Hospital, Venereal Disease Clinic, Bangkok, Thailand, with genital ulcers that were suspected clinically to be chancroid and were negative by dark-field examination for Treponema pallidum were enrolled in the study. All patients were otherwise healthy, between the ages of 18 and 60 years, and willing to return for follow-up evaluation. After informed consent was obtained, demographic and historical data were recorded, ulcers were measured, and tenderness, purulence, and induration were assessed. Ulcers were cultured for H. ducreyi and herpes simplex virus (HSV), and a blood specimen was obtained for a serological test for syphilis, complete blood count, creatinine and liver function tests, and total bilirubin, alkaline phosphatase, and asparate transfer...

Antimicrobial susceptibility of Haemophilus ducreyi

“…The introduction of these improved isolation techniques has also made it possible to correlate clinical and bacteriologic responses following therapy and to perform in vitro antimicrobial susceptibility tests (6,17,62 (29), all MIC determinations recorded to date have employed the agar dilution method (6,8,18,19,23,26,48,56,58,60,62 (13,19,23,41,50,56,60). The inoculum size ranged from 104 CFU (58) to 105 CFU (6,13,21,23,41,50,56,62), 106 CFU (7,18,22,63), and 107 CFU (66).…”

“…Both media are enriched with 0.1% glucose, 0.01% glutamine, 0.025% hemin, and 5% lysed horse blood. The incubation temperatures used by various centers have ranged from 33°C (7,8,19,23,26,66) to 35°C (13,18,20,58,62) and 37°C (55), the percent atmospheric CO2 has ranged from 5% (22,58,62) to 10o (17,19,23,41), and the duration of incubation has ranged from 24 h (6, 55) to 48 h (17,19,23,60,62) and 96 h (22,26).…”

“…Most centers have used Mueller-Hinton agar (6,7,56,62) or gonococcal agar-based medium (13,23,41,50,49,58,60) for MIC determinations. Initially, gonococcal agar base was preferred when sulfonamides were being tested (6,8,23,50), but more recently Mueller-Hinton agar base has been used (18,62).…”

Treatment of chancroid

“…The quinolones rosoxacin, ciprofloxacin, enoxacin, norfloxacin, and fleroxacin have all proved to be effective in the treatment of chancroid (1,3,4,15,23,25,26). Although some of these agents have been found to be effective following single-dose administration, the efficacy of such (23).…”

“…At the present time, multidose therapy with either erythromycin or co-trimoxazole is regarded as the treatment of choice for the disease in most endemic areas. However, recently, single-dose therapies with compounds exhibiting suitable pharmocokinetic properties and good in vitro activity against Haemophilus ducreyi have yielded cure rates in excess of 90% (34,38 days (4,5,26,40) should be regarded as treatment failures and therefore require therapy with an alternative agent. In general, clinical improvement has been associated with a decrease in pain at the ulcer site, disappearance of the purulent base of the ulcers, onset of epithelialization, and failure to reisolate H. ducreyi.…”