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Indian Journal of Medical Microbiology, Vol. 24, No. 4, October-December, 2006, pp. 345-346 Supplement A two-year study of the efficacy of azithromycin in the treatment of leptospirosis in humans Ghouse Mohamed, Maulana AB, Mohamed Ali MG], Sarasa VD Weil and Pasteur Lepto Lab Pvt Ltd, Chennai - 600 028 Code Number: mb06109 Azithromycin, a macrolide antibiotic is highly effective against both gram-positive and gram-negative organisms.[1] In-vitro studies have shown activity of azithromycin against leptospires. Though penicillin administered intravenously is a drug of choice in the treatment of leptospirosis, some patients are apprehensive to accept hospitalization when they are ambulatory and also the risk of penicillin sensitivity exists in some patients.[2] Hence this study was conducted to study the efficacy of azithromycin in human leptospirosis cases. Materials and Methods The study was conducted from March 2004 to February 2006 at two private clinics and two hospitals in Chennai. Patients suspected of leptospirosis were diagnosed by dark field microscopy (DFM) and MAT at Weil and Pasteur Lepto Lab Pvt Ltd. A total of 682 leptospirosis positive patients, tested negative for typhoid and malaria were included in the study. These patients, who were ambulatory and had no involvement of vital organs like lungs, kidney and heart were treated with azithromycin. Azithromycin was administered orally at a dose of 15 mg/kg body weight in divided doses, twice a day for one week. Patients were reviewed after one week to evaluate the remission of symptoms. Based on the feedback of the patients, the response to azithromycin was classified as good, mild and no response. If there was a good resolution of clinical signs after one week of treatment, the patients were advised to continue the same medication for one more week. In those cases in which there was a mild improvement in condition or if the symptoms did not subside after one week of azithromycin administration, the patients were advised to go for administration of parenteral antibiotics. The symptoms in patients were studied as follows: fever, abdominal pain and vomiting; fever and myalgia (calf, thigh and lower back muscles); fever, headache, neck pain and conjunctival suffusion; fever and skin rashes; Jaundice. Results and Discussion 72% of the patients (491/ 682) responded to azithromycin, with complete subsiding of the clinical symptoms. In 14.95% of the patients (102 patients), there was only a mild degree of alleviation of clinical symptoms, while 89 patients (13.05%) showed no response to treatment with azithromycin [Table - 1]. [Table - 1] also summarizes the number of patients among the high responders, with specific class of symptoms (as mentioned above in Methods). [Table - 2] shows the age-wise classification of the patients in this study and it can be seen that this drug was found to be effective in children, with the number of patients above 40 years of age being slightly lower. There was no significant difference in the efficacy of this drug in males and females. Thus, azithromycin was found to be effective in the treatment of leptospirosis in patients who were ambulatory and without the involvement of vital organs. It is thus an effective alternate to penicillin in the treatment of less severe cases of leptospirosis. References
Copyright 2006 - Indian Journal of Medical Microbiology The following images related to this document are available:Photo images[mb06109t2.jpg] [mb06109t1.jpg] |
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