- Author: Hassan I Galadari, MD; Chief Editor: William D James, MD more...
Penicillin remains the drug of choice for yaws. No resistant strains of T pallidum have been reported. Benzathine benzylpenicillin is the drug of choice for treating yaws. In remote areas where benzathine benzylpenicillin is unavailable, oral penicillin V for 7-10 days can reduce the prevalence of yaws and is effective in treating individual children with active lesions.
Empirical antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Benzathine benzylpenicillin should be avoided in patients who are allergic to penicillin; tetracycline, azithromycin, or erythromycin are alternative therapies.
Penicillin G benzathine interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity. It is given as a single injection, which kills the treponemes within minutes, and lesions become noninfectious after 18-24 hours.
Azithromycin is a semisynthetic antibiotic that is structurally similar to erythromycin. It inhibits protein synthesis in bacterial cells by binding to the 50S subunit of bacterial ribosomes. In a study in children in Papua New Guinea, oral azithromycin was found to be a reasonable alternative for treating yaws; 96% of patients in the azithromycin group were cured, compared with 93% in the benzathine benzylpenicillin group.
Tetracycline treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and, possibly, 50S ribosomal subunits. Tetracycline may be used in adults and in children who are older than 8 years and are allergic to penicillin.
Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used for the treatment of staphylococcal and streptococcal infections. In children, the proper dosage is determined by age, weight, and severity of infection. When twice-daily dosing is desired, half of the total daily dose may be taken every 12 hours. For more severe infections, the dose can be doubled.
Erythromycin may be used in adults and children who are allergic to penicillin.
Doxycycline may be used in adults with a penicillin allergy. It inhibits protein synthesis and, thus, bacterial growth by binding to 30S and, possibly, 50S ribosomal subunits of susceptible bacteria.
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