eMedicine Specialties > Dermatology > Bacterial Infections
Malakoplakia: Treatment & Medication
Updated: Oct 21, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Therapy with antibiotics that concentrate in macrophages (eg, quinolone, trimethoprim-sulfamethoxazole) is associated with a high cure rate. Antibiotic therapy directed against E coli in combination with surgery provides the best chance of cure.
- Bethanechol, a choline agonist, has been used in combination with antibiotics and surgery. Bethanechol may correct the decreased cGMP levels that are believed to interfere with complete bacterial killing.
- Ascorbic acid has been used to increase the cGMP and cyclic adenosine monophosphate (cAMP) levels in monocytes, which may represent an effective strategy for therapy. An insufficient number of patients have been treated with ascorbic acid to determine its overall effect.
- Discontinuation of immunosuppressive drug therapy is usually needed to effectively treat malakoplakia.
Surgical Care
- Excision of skin lesions and drainage of abscesses are fundamental to diagnosis and treatment.
- Surgery combined with antibiotic therapy should be directed against E coli or other organisms recovered on culture.
Consultations
- Dermatologist
- Infectious disease specialist
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Antibiotics
Antimicrobials directed against gram-negative bacteria, especially E coli, are used to treat patients with malakoplakia. In addition, antibiotics that concentrate in macrophages are used. Quinolone antibiotics (eg, ciprofloxacin) and sulfonamides (eg, trimethoprim-sulfamethoxazole) are indicated. Bethanechol and ascorbic acid have also been used in the treatment of patients with malakoplakia.
Ciprofloxacin (Cipro)
Fluoroquinolone that has activity against Pseudomonas and Streptococcus species, MRSA, Staphylococcus epidermidis, and most gram-negative organisms but has no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared.
Adult
250-500 mg PO bid for 7-14 d
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens except P aeruginosa.
Adult
160 mg TMP/800 mg SMZ PO q12h for 10-14 d
Pediatric
<2 months: Do not administer
>2 months: 10-20 mg TMP/kg/d PO/IV divided tid/qid for 14 d
May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration with diuretics increases incidence of thrombocytopenia purpura in elderly patients; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia due to folate deficiency
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBC counts frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, administer 5-15 mg/d leucovorin); caution in folate deficiency (eg, patients with chronic alcoholism, elderly patients, patients receiving anticonvulsant therapy, patients with malabsorption syndrome); hemolysis may occur in patients with G-6-PD deficiency; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); administer fluids to prevent crystalluria and stone formation
Cholinergic agents
These agents increase the contractility of the bladder.
Bethanechol hydrochloride (Duvoid, Myotonachol, Urabeth, Urecholine)
Used for selective stimulation of the bladder to produce contractions to initiate micturition and to empty the bladder. Found to be most useful in patients who have bladder hypocontractility, provided they have functional and coordinated sphincters. Rarely used because of difficulty in timing the effect and because of gastrointestinal tract stimulation.
Adult
10-50 mg PO tid/qid
Pediatric
Not established
Concurrent administration with ganglion-blocking compounds may cause decrease of blood pressure to critical levels
Documented hypersensitivity; peptic ulcer disease; obstructive pulmonary disease; bradycardia; vasomotor instability; hypotension; atrioventricular conduction defects; hyperthyroidism; epilepsy; mechanically obstructed GI or GU tract
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Urinary retention secondary to possible reflux of urine into kidneys may occur
Vitamins
Vitamins with the ability to induce collagen fibril synthesis are used.
Ascorbic acid (C-Crystals, Ascorbicap, Cevi-Bid, Vita-C)
For collagen synthesis and tissue repair.
Adult
100-250 mg PO qd/bid for a minimum of 2 wk
Pediatric
100-300 mg PO in divided doses for a minimum of 2 wk
Decreases effects of warfarin and fluphenazine; increases aspirin levels
Documented hypersensitivity; pregnancy if large dose used
Pregnancy
A - Fetal risk not revealed in controlled studies in humans
Precautions
Pregnancy category C when doses higher than RDA used; prolonged high doses may cause renal calculi, especially in patients with diabetes
More on Malakoplakia |
| Overview: Malakoplakia |
| Differential Diagnoses & Workup: Malakoplakia |
 Treatment & Medication: Malakoplakia |
| Follow-up: Malakoplakia |
| Multimedia: Malakoplakia |
| References |
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Further Reading
Keywords
malakoplakia, malacoplakia, soft plaque, genitourinary tract plaque, genitourinary tract nodule, GU tract nodule, GU tract plaque, cutaneous malakoplakia, cutaneous malacoplakia
