Ramam M, Bhat Radhakrishna, Garg Taru, Sharma Vinod K, Ray R, Singh M K, Banerjee U, Rajendran C
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Dermatol Venereol Leprol. 2007 Jul-Aug;73(4):235-9. doi: 10.4103/0378-6323.32888.
Combination antibiotic regimens are effective in the treatment of actinomycetoma but many treatment schedules require supervised parenteral therapy for prolonged periods. We describe a schedule that includes parenteral medication in an initial, short phase followed by a longer phase of oral medication.
Sixteen patients with clinically diagnosed mycetoma, who did not show any evidence of a fungal etiology, were treated presumptively for actinomycetoma. Evidence of actinomycotic infection was found on microscopy of granules / discharge and / or histopathological examination in eight (50%) patients. The treatment consisted of an intensive phase (Step 1) with gentamicin, 80 mg twice daily, intravenously and cotrimoxazole, 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with cotrimoxazole and doxycycline, 100 mg twice daily till all sinuses healed completely. The treatment was continued for 5-6 months.
Treatment response was assessed monthly. At the end of the intensive phase, there was a significant improvement in all 16 patients. Nine patients who continued the maintenance phase of the regimen had complete healing of sinuses with marked reductions in swelling and induration in 2.4 +/- 1.7 months. Maintenance treatment was continued for a mean of 9.1 +/- 4.3 months in these patients. Six patients have remained free of disease activity during a follow-up period of 11.1 +/- 4.2 months after treatment was stopped. Two patients developed leucopenia and thrombocytopenia necessitating withdrawal of cotrimoxazole.
This regimen was effective in treating actinomycetoma. The short duration of the phase requiring parenteral therapy makes it convenient to administer.
联合抗生素疗法对放线菌性足菌肿有效，但许多治疗方案需要长期的监督性肠外治疗。我们描述了一种治疗方案，该方案在初始短阶段采用肠外用药，随后是较长阶段的口服用药。
16例临床诊断为足菌肿且无真菌病因证据的患者，被推定为放线菌性足菌肿进行治疗。8例（50%）患者在颗粒/分泌物显微镜检查和/或组织病理学检查中发现放线菌感染证据。治疗包括强化阶段（步骤1），使用庆大霉素，每日静脉注射两次，每次80毫克，以及复方新诺明，每日口服两次，每次320/1600毫克，持续四周。随后是维持阶段，使用复方新诺明和强力霉素，每日两次，每次100毫克，直至所有窦道完全愈合。治疗持续5 - 6个月。
每月评估治疗反应。在强化阶段结束时，所有16例患者均有显著改善。继续该方案维持阶段的9例患者窦道完全愈合，肿胀和硬结在2.4±1.7个月内明显减轻。这些患者维持治疗的平均时间为9.1±4.3个月。6例患者在停药后的11.1±4.2个月随访期内无疾病活动。2例患者出现白细胞减少和血小板减少，需要停用复方新诺明。
该方案对治疗放线菌性足菌肿有效。需要肠外治疗的阶段持续时间短，便于给药。
