Dermatologic Manifestations of Chancroid Medication

  • Author: Mark A Hall, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 9, 2010
 

Medication Summary

Guidelines for therapy are usually based on the presenting symptoms and the clinical distribution of infection. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Successful treatment for chancroid cures the infection, resolves the clinical symptoms, and prevents chancroid transmission to others. The US Centers for Disease Control and Prevention (CDC) recommends any one of the following treatments for chancroid:

  • Azithromycin 1 g orally in a single dose
  • Ceftriaxone 250 mg intramuscularly in a single dose
  • Ciprofloxacin 500 mg orally twice a day for 3 days
  • Erythromycin base 500 mg 3 times a day for 7 days

Ciprofloxacin is contraindicated for pregnant and lactating women. Azithromycin and ceftriaxone offer the advantage of single-dose therapy.[30] Worldwide, several isolates with intermediate resistance to either ciprofloxacin or erythromycin have been reported.[25, 31]

A 2009 study of 54 subjects from Brazil suggests that single-dose therapy with thiamphenicol (89% cure rate) is more effective than single-dose therapy with azithromycin (73% cure rate). However, HIV seropositivity was associated with treatment failures. Notably, all HIV-positive subjects treated with azithromycin had treatment failure, prompting the authors to recommend avoiding azithromycin in HIV-coinfected patients.[32]

Uncircumcised men and patients who are infected with HIV do not respond to therapy as well as others. Chancroid relapses after antibiotic therapy in as many as 5% of patients, and relapses are more common in patients who are uncircumcised or are infected with HIV. If they are not infected with HIV, repeating the original therapy is usually effective.

Because chancroid treatment is often accompanied by treatment for gonococcal infections, it is important to be aware of changes to the CDC guidelines for STDs. In April 2007, the CDC updated treatment guidelines for gonococcal infection and associated conditions. Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States. The recommendation was based on data from the CDC's Gonococcal Isolate Surveillance Project (GISP) published in the April 13, 2007, issue of the Morbidity and Mortality Weekly Report. This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125 mg intramuscularly once as a single dose).

For more information see, the CDC's Antibiotic-Resistant Gonorrhea Web site; CDC Updated Gonococcal treatment recommendations (April 2007); or Medscape Medical News on CDC Issues - New Treatment Recommendations for Gonorrhea.

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Antibiotic, Macrolide

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Azithromycin (Zithromax)

 

Acts by binding to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.

Concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues.

Treats mild-to-moderate microbial infections. Plasma concentrations are very low, but tissue concentrations are much higher, giving it value in treating intracellular organisms. Has a long tissue half-life.

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Erythromycin (E-Mycin, Eryc, Ery-Tab)

 

Recommended dosing schedule may result in GI upset, causing one to prescribe alternative macrolide or change to tid dosing. Covers most potential etiologic agents, including Mycoplasma species.

Less active against Haemophilus influenzae. Although 10 d seems to be standard course of treatment, treating until patient has been afebrile for 3-5 d seems more rational. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Indicated for staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

Has added advantage of being a good anti-inflammatory agent by inhibiting migration of polymorphonuclear leukocytes.

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Antibiotic, Cephalosporin

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Ceftriaxone (Rocephin)

 

Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

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Antibiotic, Quinolone

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Ciprofloxacin (Cipro)

 

Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Has no activity against anaerobes. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared.

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Contributor Information and Disclosures
Author

Mark A Hall, MD  President/Founder, Central Oregon Dermatology, PC

Mark A Hall, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Janet Fairley, MD  Professor and Head, Department of Dermatology, University of Iowa

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Chancroid usually starts as a small papule that rapidly becomes pustular and eventually ulcerates. The ulcer enlarges, develops ragged undermined borders, and is surrounded by a rim of erythema. Unlike syphilis, lesions are tender and the border of the ulcer is not indurated. Courtesy of Hon Pak, MD.
This patient shows the characteristic lesions of chancroid. The bubo on the right side drained spontaneously. The bubo in the left inguinal canal required needle aspiration.
Close-up view of chancroid ulcers.
Large fluctuant buboes should be drained with the patient under local anesthesia and a large-gauge needle inserted through surrounding healthy skin. The insertion site should be superior or lateral to the bubo to prevent chronic drainage from the site.
 
 
 
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