Lymphogranuloma Venereum in Emergency Medicine Medication

  • Author: Andrew C Bushnell, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 17, 2009
 

Medication Summary

The goal of therapy is to eradicate the pathogen.

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Antibiotics

Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

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Doxycycline (Doryx, Bio-Tab, Vibramycin)

 

Broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. Almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Sexual contacts of confirmed cases seen within 30 d of confirmed case diagnosis need to receive a prophylactic regimen of either azithromycin or doxycycline.

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Erythromycin (EES, Ery-Tab, Erythrocin)

 

Inhibits RNA-dependent protein synthesis, possibly by stimulating dissociation of peptidyl tRNA from ribosomes. This inhibits bacterial growth. In children, age, weight, and severity of infection determine proper dosage. When bid dosing desired, half-total daily dose may be taken every 12 h. For more severe infections, dose may be doubled.

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Sulfisoxazole

 

Sulfonamide derivative that exerts its bacteriostatic action by antagonizing para-aminobenzoic acid (PABA), an essential component in folic acid synthesis. Microorganisms susceptible to this medication are those that depend on folic acid synthesis for growth and cannot use exogenous folic acid.

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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.

Recent evidence suggests that use of azithromycin for 3 wk is a sufficient course. However, more studies using this regimen need to be completed.

Sexual contacts of confirmed cases seen within 30 d of confirmed case diagnosis need to receive a prophylactic regimen of either azithromycin or doxycycline.

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Contributor Information and Disclosures
Author

Andrew C Bushnell, MD, FACEP  Department of Surgery, Division of Emergency Medicine, Assistant Professor, University of Vermont College of Medicine

Andrew C Bushnell, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP  Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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