Lymphogranuloma Venereum (LGV) in Emergency Medicine Medication

Updated: May 23, 2017
  • Author: Jesse Tran, DO; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Medication

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.

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.

Treatment should be 21 days duration.

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

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. This is considered an alternative treatment by the Centers for Disease Control and Prevention and likewise should be administered for 21 days. When bid dosing desired, half-total daily dose may be taken every 12 h. For more severe infections, dose may be doubled.

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.

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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