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Yaws Medication

  • Author: Hassan I Galadari, MD; Chief Editor: William D James, MD  more...
 
Updated: Aug 17, 2015
 

Medication Summary

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.[18]

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Antibiotics

Class Summary

Empirical antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.[19] Benzathine benzylpenicillin should be avoided in patients who are allergic to penicillin; tetracycline, azithromycin, or erythromycin are alternative therapies.

Penicillin G benzathine (Bicillin LA)

 

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 (Zithromax, Zmax)

 

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,[20] 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

 

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 (E.E.S., Erythrocin, Ery-Tab)

 

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 (Adoxa, Alodox, Doryx, Vibramycin)

 

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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Contributor Information and Disclosures
Author

Hassan I Galadari, MD Assistant Professor of Dermatology, Faculty of Medicine and Health Sciences, United Arab Emirates (UAE) University, UAE

Hassan I Galadari, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Medical Student Association/Foundation, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose

Gary L Gorby, MD Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Natalie C Klein, MD, PhD Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York County Medical Society

Disclosure: Nothing to disclose.

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

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.

Caroline L Levine, MD Staff Physician, Department of Dermatology, Emerson Hospital, Mt Aburn Hospital

Caroline L Levine, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

References
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  2. Sanchez MR. Endemic (Nonvenereal) Treponematoses. Freedberg IM, Eisen AZ, Wolff K, Austen F, Goldsmith LA, Katz S, eds. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York, NY: McGraw-Hill; 2003.

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  7. Consultation on yaws elimination 5-7 March 2012, WHO Headquarters, Geneva, Room M505. Available at http://www.who.int/neglected_diseases/NTD_RoadMap_2012_Fullversion.pdf. Accessed: July 30, 2012.

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  10. Agmon-Levin N, Bat-sheva PK, Barzilai O, et al. Antitreponemal antibodies leading to autoantibody production and protection from atherosclerosis in Kitavans from Papua New Guinea. Ann N Y Acad Sci. 2009 Sep. 1173:675-82. [Medline].

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  16. Engelkens HJ, ten Kate FJ, Judanarso J, et al. The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws. Genitourin Med. 1993 Apr. 69(2):102-7. [Medline].

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  18. Scolnik D, Aronson L, Lovinsky R, Toledano K, Glazier R, Eisenstadt J, et al. Efficacy of a targeted, oral penicillin-based yaws control program among children living in rural South America. Clin Infect Dis. 2003 May 15. 36(10):1232-8. [Medline].

  19. Manirakiza A, Boas SV, Beyam NE, Zadanga G, Konamna FX, Njuimo SP, et al. Clinical outcome of skin yaws lesions after treatment with benzathinebenzylpenicillin in a pygmy population in Lobaye, Central African Republic. BMC Res Notes. 2011 Dec 15. 4(1):543. [Medline].

  20. Mitjà O, Hays R, Rinaldi AC, McDermot R, Bassat Q. New treatment schemes for yaws: the path toward eradication. Clin Infect Dis. 2012 Aug. 55(3):406-12. [Medline].

 
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Initial papilloma, also called mother yaw or primary frambesioma (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Plantar papillomata with hyperkeratotic macular plantar early yaws (ie, crab yaws) (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta.Geneva, Switzerland: World Health Organization; 1984.).
Osteoperiostitis of the tibia and fibula in early yaws (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Early yaws papillomata (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Early ulceropapillomatous yaws on the leg (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
Squamous macular palmar yaws (from Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.).
 
 
 
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