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Jos Bogaerts, Luc Kestens, Waldina Martinez Tello, Jeannette Akingeneye, Véronique Mukantabana, Jan Verhaegen, Eddy Van Dyck, Peter Piot, Failure of Treatment for Chancroid in Rwanda Is Not Related to Human Immunodeficiency Virus Infection: In Vitro Resistance of Haemophilus ducreyi to Trimethoprim-Sulfamethoxazole, Clinical Infectious Diseases, Volume 20, Issue 4, April 1995, Pages 924–930, https://doi.org/10.1093/clinids/20.4.924
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Abstract
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.
