The demographic and behavioural profile of women with cervicitis infected with Chlamydia trachomatis,Mycoplasma hominis and Ureaplasma urealyticum and the comparison of two medical regimens

Objective: The aim of this study was to compare the therapeutic effect of single dose oral azithromycin with twice-daily, 7-day doxycycline in women with chlamydial, mycoplasmic or ureaplasmic cervicitis and to demonstrate the demographic and behavioral profile of infected women. Materials and methods: Five hundred and thirty-three women with various gynecologic complaints were recruited for this study. All women were screened for Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) by enzyme immune assay tests. Patients positive for Neisseria gonorrhoeae were excluded. Women treated for these infections were tested after completing medical therapy. Educational levels of infected women were similar in each group. The prevalence of CT, UU and MH was 3.4% (18/533), 11.8% (63/533) and 0.9% (5/533), respectively. In 452 patients, no treatment was administered. The remaining patients were either treated with azithromycin (n=41) or doxycycline (n=40). The eradication rate for the infectious agents was 87.3% and 93.5% in the group of azithromycin and doxycycline, respectively (P>0.05). There was no statistically significant difference in efficacy between single dose azithromycin and a 7-day course of doxycycline with respect to the treatment of culture-positive cases. Recurrences were observed in five cases in azithromycin group (12.5%) and in three cases in doxycycline group (7.5%) . Conclusions: The treatment of uncomplicated chlamydial, mycoplasmic and ureaplasmic cervicitis with a single dose of azithromycin administered under supervision in the clinic is as effective as a 7-day course of doxycycline. This regimen may overcome the problem of compliance with the standard twice-daily, 7-day regimen of doxycycline.     

Modification of the pharmacokinetics of doxycycline in man by ferrous sulphate or charcoal

Summary In order to study the intestinal interactions of doxycycline (DC) with Fe⁺⁺ and charcoal, two groups of healthy volunteers were given either 200 mg or 100 mg DC in capsules at 2 p. m. and 9 p. m., and blood samples for fluorimetric assay of DC were collected for 24 h starting at 8.30 a. m. on the following morning. A 24-h-urine was also collected. The test was subsequently repeated at one-week intervals, when the volunteers also ingested either ferrous sulphate (80 mg Fe⁺⁺) or charcoal (4.0 g) immediately after the zero-time sample of DC and at 3, 8 and 12 h. Charcoal completely adsorbed DC in vitro in an artificial small intestinal fluid. Ferrous sulphate or charcoal did not modify the serum level or urinary excretion of DC after the 200 mg+200 mg dose, but ferrous sulphate did reduce the 24-h urinary excretion of DC after the 100 mg+100 mg dose. The serum half-life and AUC of DC were reduced by ferrous sulphate given after the 100 mg+100 mg dose of DC. Charcoal did not modify any parameter, even after the 100 mg+100 mg dose of DC. The results do not support existence of important enteral cycling of DC. Although oral ferrous sulphate can lower the serum level and shorten the serum half-life of DC, the acute experiment suggested that a therapeutic serum level of DC can be maintained despite treatment with iron in the doses used in iron-deficiency, and charcoal in the doses used in diarrhoeic states, if the drugs are administered several hours apart.     

Outbreak of scrub typhus in the North East Himalayan region-Sikkim: An emerging threat

Scrub typhus is an acute febrile illness that is known to be endemic in the South East Asian countries and the Western Pacific region. We here report an outbreak in the tiny Himalayan state of Sikkim. Patients with pyrexia of unknown origin were evaluated. They were screened by Weil–Felix test and the rapid immunochromatographic method. Samples that were positive by either Weil–Felix agglutination test or by rapid immunochromatography were confirmed by IgM enzyme-linked immunosorbent assay (ELISA). A total 204 samples were screened. Sixty-three patients were confirmed positive among which 42 were male and 21 were female. Effective management and early administration of antibiotics will help prevent the complications and mortality associated with scrub typhus.     

Helicobacter pylori Eradication with Doxycycline—Metronidazole—Bismuth Subcitrate Triple Therapy

Triple therapy containing tetracycline HC1 is currently among the most efficient combination therapies for eradication of Helicobacter pylori. Substitution of doxycycline for tetracycline HCl offers advantages of less frequent dosing and extrarenal excretion. In this study patients with duodenal ulcer or non-ulcer dyspepsia positive for H. pylori were randomized to either doxycycline or tetracycline HCl triple therapy in conjunction with bismuth subcitrate and metronidazole. Of the 34 patients taking doxycycline, only 22 (65%) achieved H. pylori eradication at the 4-week rebiopsy, compared with 36 of 39 (92%) taking tetracycline HCl (p = 0.004). We conclude that doxycycline-containing triple therapy is less effective for H. pylori eradication and offers no clinical advantage over tetracycline HCl-containing triple therapy.     

Cardiac implications of Lyme disease, diagnosis and therapeutic approach

Lyme is a tick-borne disease. The genetic diversity of Borreliae its distribution worldwide and its epidemiology have been related to different clinical manifestations. Carditis is a rare manifestation of Lyme disease. The commonest abnormality is atrioventricular block of various degrees, though other rhythm abnormalities have been reported. Pericarditis, myocarditis, cardiomyopathy and degenerative valvular disease have been associated with B. burgdorferi. Temporary pacing might be required in unstable patients. The majority of the conduction disturbances have a benign prognosis, if the infectious agent is identified and treated appropriately.     

疗程与药物配伍对布氏菌病疗效的影响

目的筛选对本地区布氏菌病急性期最敏感的抗生素，为今后制定防治策略提供科学依据。方法采用不同药物配伍、不同疗程、分成6组（492例）进行治疗和对比研究。结果含强力霉素治疗组（85．66％）效果优于未含强力霉素组（58．97％），差异有显著性（P〈0．001）。如增加疗程，疗效增加不明显。结论治疗急性及慢性期急性发作布病患者，使用抗菌素应首选强力霉素配伍，3个疗程即可取得满意疗效。     

The Effects of Intrapleural Polyclonal Anti-Tumor Necrosis Factor alpha (TNFα) Fab Fragments on Pleurodesis in Rabbits

The mechanism by which various agents produce a pleurodesis is unknown. The purpose of this project was to determine whether the pleurodesis that results from the intrapleural administration of talc or doxycycline depends on tumor necrosis factor alpha (TNFα). In a randomized, blinded, placebo-controlled study, 34 New Zealand white rabbits were given 400 mg talc or 10 mg/kg doxycycline intrapleurally as a sclerosant through a chest tube. Half the rabbits in each group were also given 2,000 units of ovine, polyclonal affinity purified anti-TNFα Fab, or saline as placebo immediately after and 12 h after the injection of the sclerosant. Chest tubes were aspirated at 12-h intervals until their removal at 4 days. Rabbits were killed at 28 days. The pleural fluid volume, cell counts, lactate dehydrogenase (LDH) and pleurodesis scores were compared among groups. Both talc and doxycycline produced an exudative pleural effusion. The pleural fluid volume and the pleural fluid LDH levels were significantly (p < 0.05) greater in the group given doxycycline. The administration of anti-TNFα Fab had no significant effect on pleural fluid volume or leukocyte count in either group. However, the administration of anti-TNFα Fab resulted in a significant decrease (p= 0.004) in the pleurodesis score for the animals given talc (3.2 ± 0.8 without Fab and 1.8 ± 0.9 with Fab). In contrast, the pleurodesis score was virtually identical in the doxycycline group with (3.5 ± 0.5) and without (3.4 ± 0.7) Fab. The administration of anti-TNFα Fab diminishes the pleurodesis induced by talc but not that resulting from doxycycline. These findings suggest that different mechanisms are involved with the two different sclerosants. Accepted for publication: 30 September 1999