Antimicrobial Agents

Abstract

Several points are worth clarifying in the article, “Tetracyclines, Chloramphenicol, Erythromycin, and Clindamycin,” by Wilson and Cockerill in the October 1987 issue of the Proceedings (pages 906 to 915), because it is part of an excellent symposium on antimicrobial agents that will likely be quoted often. The dosages recommended for erythromycin in Table 3 (1 to 4 g every 6 hours orally and 1 to 2 g every 6 hours intravenously) are toxic and intolerable. The correct doses are 250 mg to 1 g and 500 mg to 1 g, respectively. The authors state that chancroid may be treated with tetracycline. The Centers for Disease Control no longer recommends this treatment, as most strains of Haemophilus ducreyi are resistant to tetracycline;1Fast MV Nsanze H D'Costa LJ Karasira P Maclean IW Piot P Albritton WL Ronald AR Antimicrobial therapy of chancroid: an evaluation of five treatment regimens correlated with in vitro sensitivity.Sex Transm Dis. 1983; 10: 1-6Crossref PubMed Scopus (30) Google Scholar, 2Bilgeri YR Ballard RC Duncan MO Mauff AC Koornhof HJ Antimicrobial susceptibility of 103 strains of Haemophilus ducreyi isolated in Johannesburg.Antimicrob Agents Chemother. 1982; 22: 686-688Crossref PubMed Scopus (20) Google Scholar erythromycin, trimethoprim-sulfamethoxazole, or cef-triaxone, among other drugs, is acceptable therapy. The authors also suggest that “tetracycline may also be used in the treatment of gonococcal infections in patients unable to tolerate penicillin.” Stamm and colleagues3Stamm WE Guinan ME Johnson C Starcher T Holmes KK McCormack WM Effect of treatment regimens for Neisseria gonorrhoeae on simultaneous infection with Chlamydia trachomatis.N Engl J Med. 1984; 310: 545-549Crossref PubMed Scopus (193) Google Scholar showed tetracycline to be significantly inferior to other regimens in treating women with gonorrhea. With the increase in tetracycline-resistant strains and the availability of more efficacious, equally safe alternatives for penicillin-allergic patients, tetracycline alone is probably not ideal. Wilson and Cockerill also state that “epididymitis is usually caused by gonococci or C. trachomatis and is effectively treated with tetracycline.” This statement is certainly true for young patients; however, in men older than 35 years of age and in homosexuals, Entero-bacteriaceae and Pseudomonas are found much more frequently4Berger RE Alexander ER Harnisch JP Paulsen CA Monda GD Ansell J Holmes KK Etiology, manifestations and therapy of acute epididymitis: prospective study of 50 cases.J Urol. 1979; 121: 750-754PubMed Google Scholar and would be inadequately treated by tetracycline. Finally, Table 4, which gives susceptibility data on various gram-negative bacilli not routinely treated with tetracycline, may be interpreted by the uninitiated to have practical clinical relevance. As a minor point, I respectfully suggest that more useful information on organisms usually treated with tetracycline could be substituted in its place. Antimicrobial Agents: Dr. Wilson repliesMayo Clinic ProceedingsVol. 63Issue 2PreviewDr. Cockerill and I appreciated receiving the letter from Dr. Glatt about our Proceedings article. I would like to respond to the following points in his letter. Full-Text PDF