Randomized double-blind evaluation of ciprofloxacin and doxycycline for Mediterranean spotted fever

Gudiol, Francesc; Pallarés, Román; Carratalà, Jordi; Bolao, Ferrán; Ariza, Javier; Rufí, Gabriel; Viladrich, Pedro F.

doi:10.1128/aac.33.6.987

Cited by 54 publications

(23 citation statements)

References 9 publications

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“…The results obtained by the immunofluorescence assay are not consistent with clinical experience, suggesting that the method should be reconsidered. Patients suffering from Mediterranean spotted fever have been successfully treated with fluoroquinolones (4,8,13,19), and thus, fluoroquinolones may be considered a safe alternative to tetracyclines for the treatment of rickettsial diseases. During pregnancy and childhood, macrolide compounds may represent a safe alternative to doxycycline and fluoroquinolones.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Antibiotic Susceptibilities of Three Rickettsial Species Including Rickettsia felis by a Quantitative PCR DNA Assay

Rolain

Stuhl

Maurin

et al. 2002

Antimicrob Agents Chemother

114

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Rickettsiae grow only intracellularly, and the antibiotic susceptibilities of these bacteria have been assessed by either plaque, dye uptake, or immunofluorescence assays, which are time-consuming. We used a quantitative PCR (with the LightCycler instrument) to assess the levels of inhibition of Rickettisa felis, R. conorii, and R. typhi DNA synthesis in the presence of various antibiotics. We established the kinetics of rickettsial DNA during growth and showed that R. conorii grows more quickly than R. typhi in cell culture, with maximum replication occurring after 5 and 7 days, respectively. The MICs of the antibiotics tested for R. conorii and R. typhi by the quantitative PCR assay were similar to those previously obtained by plaque and dye uptake assays. We found that R. felis is susceptible to doxycycline, rifampin, thiamphenicol, and fluoroquinolones but not to gentamicin, erythromycin, amoxicillin, or trimethoprim-sulfamethoxazole. The resistance of this new species to erythromycin is consistent with its current taxonomic position within the spotted fever group. We believe that quantitative PCR could be used in the future to simplify and shorten antibiotic susceptibility assays of other rickettsiae and other strict intracellular pathogens.Rickettsiae are strict intracellular bacteria belonging to the alpha group of the class Proteobacteria (15). Rickettsioses are zoonoses that have geographical distributions similar to those of their vectors. The genus comprises the spotted fever group rickettsiae and the typhus group rickettsiae, which includes Rickettsia prowazekii, the agent of epidemic typhus, and R. typhi, the agent of murine typhus (16). Since they are obligate intracellular bacteria, in vitro studies of their susceptibilities to antibiotics necessitate the use of cell culture systems. Using the plaque assay and the dye uptake assay (18), we have now described the antibiotic susceptibilities of most of the rickettsiae with the exception of R. felis, which, until recently, was not available to us. The two assays depend on the induction of cytopathic effects and plaque formation in cell cultures by the rickettsiae, but some rickettsiae do not normally cause cytopathic effects in primary cultures (18). Recently, Ives et al.(5-7) described a new assay that uses immunofluorescence staining, which avoids the problem of a lack of cytopathic effects. A lack of cytopathic effects occurs with R. felis, the agent of flea-borne spotted fever, which we have now isolated and cultured in a Xenopus laevis cell line (XTC-2 cells) (14) and in Vero cells. To determine the antibiotic susceptibility of this species we developed an original antibiotic assay using PCR with the LightCycler instrument. It is a new, real-time PCR technique which has been used to diagnose several bacterial infections (3) but which has not been used to determine antibiotic susceptibilities. The technique combines PCR amplification and detection of products in a single optically clear glass capillary tube, which enables rapid temperature transi...

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Section: Discussionmentioning

confidence: 99%

Evaluation of Antibiotic Susceptibilities of Three Rickettsial Species Including Rickettsia felis by a Quantitative PCR DNA Assay

Rolain

Stuhl

Maurin

et al. 2002

Antimicrob Agents Chemother

114

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“…Although some fluoroquinolones have in vitro activity against rickettsiae (200), their use for treatment of certain rickettsial infections has been associated with delayed subsidence of fever, increased disease severity, and longer hospital stay (201,202). No human efficacy data on fluoroquinolone use in RMSF exist, and fluoroquinolones are not recommended for treatment of RMSF (77).…”

Section: Alternative Antibacterial Agents To Doxycyclinementioning

confidence: 99%

Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States

Biggs¹,

Behravesh²,

et al. 2016

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“…mycin proved to be less effective than tetracycline hydrochloride (12). Ciprofloxacin (13) and pefloxacin (14) were shown to be effective, although to a lesser degree than doxycycline (15). Until now, tetracyclines continue to be the treatment of choice in MSF and other rickettsioses.…”

mentioning

confidence: 98%

Evaluation of ciprofloxacin and doxycycline in the treatment of mediterranean spotted fever

Beltran

Herrero

1992

Eur. J. Clin. Microbiol. Infect. Dis.

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A comparison was made of the results obtained with ciprofloxacin (750 mg/12 h) and doxycycline (100 mg/12 h), both administered p.o. for one week, in 34 and 36 patients respectively with Mediterranean spotted fever. Apyrexia was achieved after 50.1 +/- 34.2 h (mean +/- SD) of antibiotic therapy in the group of patients treated with ciprofloxacin and in 55.2 +/- 23.3 h in the group treated with doxycycline (no significant statistical differences). Resolution of the remaining signs and symptoms of the disease was achieved faster with ciprofloxacin. Both therapeutic regimens were effective and safe. Although more expensive than doxycycline, ciprofloxacin is a bactericidal compound which is better tolerated and has a lower risk of toxicity and of development of resistance. It can be considered, together with doxycycline, as an antibiotic of first choice in the treatment of Mediterranean spotted fever.

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Randomized double-blind evaluation of ciprofloxacin and doxycycline for Mediterranean spotted fever

Abstract: A study of 43 patients with Mediterranean spotted fever showed that a 2-day course of ciprofloxacin or a 2-day course of doxycycline may be an effective mode of therapy. All patients in both arms of the study were cured; however, doxycycline produced a more rapid defervescence.

Cited by 54 publications

References 9 publications

Evaluation of Antibiotic Susceptibilities of Three Rickettsial Species Including Rickettsia felis by a Quantitative PCR DNA Assay

Evaluation of Antibiotic Susceptibilities of Three Rickettsial Species Including Rickettsia felis by a Quantitative PCR DNA Assay

Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States

Evaluation of ciprofloxacin and doxycycline in the treatment of mediterranean spotted fever

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