Louse-borne relapsing fever: II. Combined penicillin and tetracycline therapy in 160 Sudanese patients

One hundred and sixty patients with louse-borne relapsing fever were treated with a combination therapy of procaine penicillin and tetracycline. Fortified procaine penicillin B.P. was given as 400,000 units in the first day. This was followed the next day by 2 g tetracycline orally in divided doses for seven days. A mild rise in temperature was observed in 22 (13·7%) patients within four hours of administering penicillin. Rigors and hypotension occurred in one patient. Relapse occurred in two patients, of whom one had concomitant typhoid and one visceral leishmaniasis. The combined therapy has been found to be effective and safe. It lacks the disadvantages of penicillin (relapses) and tetracycline (severe reaction), when each drug is used alone.The use of the arsenicals (Wolffet al., 1946; Garnhamet al., 1947), penicillin (Taft & Pike, 1945; Ingraham & Lepenta, 1946; Harrison & Whittington, 1951; Knaacket al., 1972) and tetracycline (Brycesonet al., 1970; Knaacket al., 1972) in louse-borne relapsing fever has resulted in a dramatic reduction of the mortality rate from more than 40% in untreated cases (Garnhamet al., 1947) to less than 5%. However, each of these drugs suffers from one drawback or another. The arsenicals are toxic (Wolffet al., 1946). Penicillin is slow in clearing the spirochaetaemia, has a higher rate of relapse and does not clear residual infection in the brain (Harrison & Whittington, 1951). Tetracycline almost invariably induces a distressing Jarisch-Herxheimer reaction (Brycesonet al., 1970; Knaacket al., 1972; Perineet al., 1974). The combined use of penicillin (to reduce reaction) and tetracycline (to prevent relapses) can be a safe and effective alternative in the treatment of this disease. This paper describes the treatment of 160 Sudanese patients with louse-borne relapsing fever, using combined penicillin and tetracycline.