Chancroid in Emergency Medicine Medication

Updated: Jun 17, 2019
  • Author: Kristine Song, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Medication

Medication Summary

CDC treatment guidelines for chancroid recommend one of the following options: [15]

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

Resistance to ciprofloxacin and erythromycin has been reported.

A 2017 Cochrane literature review comparing the efficacy of macrolides for the treatment of H ducreyi infection in sexually active adults found low-quality evidence to suggest there is no statistically significant difference between azithromycin and the available therapeutic alternatives and suggested that azithromycin could be considered as first-line therapy. [16]

The goal of therapy is to eradicate the microorganism. Since treatment of chancroid may accompany treatment of gonorrhea, it is important to be aware of the updated CDC guidelines for treating 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 analysis of new data from the CDC's Gonococcal Isolate Surveillance Project (GISP). According to these data, the proportion of gonorrhea cases in heterosexual men that were fluoroquinolone-resistant (QRNG) reached 6.7%, an 11-fold increase from 0.6% in 2001. The data were published in the April 13, 2007, issue of the Morbidity and Mortality Weekly Report. [18] This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose). Fluoroquinolones may be an alternative treatment option for disseminated gonococcal infection if antimicrobial susceptibility can be documented.

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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Antibiotics

Class Summary

These agents are always indicated in chancroid. Therapy must be aimed at covering all likely pathogens according to the clinical setting.

Azithromycin (Zithromax)

Used to treat mild to moderately severe infections caused by susceptible strains of microorganisms. Indicated for chlamydial and gonorrheal infections of genital tract.

Ceftriaxone (Rocephin)

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

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

Blocks peptide bond formation by blocking peptidyl tRNA translocation from the A- to the P- site. Inhibits bacterial growth.

Ciprofloxacin (Cipro)

Bactericidal antibiotic that inhibits bacterial DNA synthesis, and consequently growth, by inhibiting DNA-gyrase in susceptible organisms. Indicated for pseudomonal infections and those due to multidrug-resistant gram-negative organisms. If co-infection with gonorrhea suspected, do not use fluoroquinolones. CDC no longer recommends fluoroquinolones for gonorrhea or related conditions because of resistance.

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