Failure of Treatment for Chancroid in Rwanda Is Not Related to Human Immunodeficiency Virus Infection: In Vitro Resistance of Haemophilus ducreyi to Trimethoprim-Sulfamethoxazole

• Published in: Clinical infectious diseases 1995-04, Vol.20 (4), p.924-930
• Main Authors: Bogaerts, Jos, Kestens, Luc, Tello, Waldina Martinez, Akingeneye, Jeannette, Mukantabana, Véronique, Verhaegen, Jan, Van Dyck, Eddy, Piot, Peter
• Format: Article
• Language: English
• Subjects: Adult; AIDS; AIDS/HIV; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; CD4 Lymphocyte Count; Chancroid; Chancroid - blood; Chancroid - complications; Chancroid - drug therapy; Ciprofloxacin - pharmacology; Ciprofloxacin - therapeutic use; Clinical Articles; Dosage; Drug Resistance, Microbial; Female; Follow-Up Studies; Genitalia; Haemophilus ducreyi; Haemophilus ducreyi - drug effects; Health outcomes; HIV infections; HIV Infections - complications; Humans; Infections; Lymphocytes; Male; Medical sciences; Microbial Sensitivity Tests; Pharmacology. Drug treatments; Rwanda; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination - pharmacology; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Tropical medicine; Ulcers
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/20.4.924

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, ⩾4/76 µg/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.