A single dose of ceftriaxone (250 mg) administered intramuscularly was compared with trimethoprim-sulfamethoxazole (TMP-SMZ; 160/800 mg) administered orally twice daily for seven days or with a single dose of TMP-SMZ (640/3,200 mg) administered orally for the treatment of chancroid in men in Thailand. Haemophilus ducreyi was isolated from 79 (48%) of 164 men with a clinical diagnosis of chancroid. For men with ulcers that were culture positive for H. ducreyi, rates of cure were 100% in 25 men treated with ceftriaxone, 87% in 23 men given TMP-SMZ for seven days, and 55% in 31 men given TMP-SMZ in a single dose. For men with ulcers that were culture negative for H. ducreyi, rates of cure were 100% in 29 men treated with ceftriaxone, 66% in 32 men given TMP-SMZ for seven days, and 63% in 24 men given TMP-SMZ in a single dose. The MIC50 of the three antibiotics for 94 isolates of H. ducreyi were as follows: 0.004 micrograms/ml for ceftriaxone, 16 micrograms/ml for trimethoprim, and greater than 512 micrograms/ml for sulfamethoxazole. Our study indicates that ceftriaxone in a single dose of 250 mg is effective, but that TMP-SMZ, even when given in a standard seven-day regimen, is not effective treatment for chancroid in Thailand.
To determine how frequently mothers infect their infants with enteric pathogens at birth, stools were collected from 75 Thai mothers immediately before delivery and from their infants 24-48 h later. Enteropathogenic Escherichia coli (EPEC) were isolated from 25 of the 75 mothers just prior to delivery (32%), enteroviruses from six (8%), enterotoxigenic E. coli from five (7%), and shigella, salmonella and Vibrio parahaemolyticus each from one (1%). EPEC serotype 0128:K67 was isolated from one mother and from her infant, neither of whom had diarrhoea. Cultures from the other 74 mother-infant pairs did not detect identical enteric pathogens. Eighteen infants, nine of whose mothers submitted stools prior to delivery, developed diarrhoea within 5 days of birth. Five infants were infected with ETEC (28%), three with EPEC serotype 020a020cK61 (17%), one with Campylobacter jejuni (6%), and one with rotavirus (6%). None of these enteropathogens was found in 66 infants without diarrhoea. ECHO viruses of two different serotypes were isolated from two of 18 newborns with diarrhoea and unidentified enteroviruses from three of 66 without diarrhoea. Mothers and nurses are frequently infected with enteric pathogens in Thailand, but transmission to newborns at birth appears to be uncommon.
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