Oral Antibiotic As Good As Penicillin Shot For Syphilis

September 21, 2005 08:41:05 PM PST
Just one dose in pill form of the antibiotic azithromycin, better known as Zithromax, treats early-stage syphilis as well as a shot of penicillin.

"Single-dose oral azithromycin is effective in treating syphilis, and may be particularly useful in developing countries in which the use of penicillin G benzathine injections is problematic," wrote the authors of a recent study comparing the two drugs.

"However, recent reports of azithromycin-resistant Treponema pallidum in the United State indicate the importance of continued monitoring for resistance," they added.

Results of the study appear in the Sept. 22 issue of the New England Journal of Medicine.

The U.S. Centers for Disease Control and Prevention report that as many as 32,000 Americans are infected with syphilis each year. The disease, which is caused by the bacterium T. pallidum, can only be spread through direct person-to-person contact, such as sexual intercourse or oral sex. It cannot be contracted through toilet seats, swimming pools or hot tubs, according to CDC.

The first symptom of infection is generally a single sore, called a chancre. Eventually, the chancre disappears, and the infection enters the secondary and then late phase. In the early phase, a single injection of penicillin can easily eradicate the infection. If the disease has progressed to the secondary or late stage, a longer course of antibiotics is usually needed.

The current study included 328 people from Mbeya, Tanzinia, who were diagnosed with early syphilis. The average age of the study participant was 27, and almost 72 percent were female.

The study volunteers were randomly assigned to receive either 2 grams of oral azithromycin (163 people) or 2.4 million units of penicillin G benzathine by injection (165 people).

Nine months after treatment, almost 98 percent of those in the azithromycin group were cured vs. 95 percent in the penicillin group.

"This is a well-carried out study that adds options for treatment, but not options we hadn't already thought of," said Dr. Charles Gonzalez, an infectious disease specialist at New York University Medical Center.

"We already use Zithromax for penicillin-allergic patients. There are also logistical benefits to a pill. It's actually a little bit less expensive, because you don't have to have a pharmacist mix it, and a nurse to administer it. It's also easier to keep a pill stored on a shelf," he said.

But, he added, "The difficulty is, with large-scale distribution, we worry about a resistance pattern."

"The presence of resistance in North America and Ireland makes the routine use of azithromycin a very risky proposition," said Sheila Lukehart, a professor of medicine at the University of Washington in Seattle.

Last year, Lukehart published a study in the New England Journal of Medicine that found almost 90 percent of samples taken in Dublin, Ireland, and nearly 40 percent of samples of T. pallidum taken in San Francisco contained a genetic mutation making it resistant to azithromycin.

"The decision about using azithromycin needs to be based carefully on what you know about the strains in that community, which means we need to be doing surveillance. So far, there's no concerted surveillance effort ongoing in most of this country and worldwide," she explained.

"There are macrolide-resistant T. pallidum spreading along the West Coast right now. We don't know whether this was a single resistant strain that is now spreading, or if it's new resistance that is developing. We don't know which of those two is occurring," she added. "If it's a new resistance that is developing, it could doom azithromycin for treatment of syphilis," Lukehart said. "If it's a limited number of already-resistant strains traveling through sexual networks, and if you know that these strains are rarely present in your community, it's probably fine to use azithromycin. Again, this requires surveillance and careful follow-up."

For someone with syphilis, Lukehart said, what's most important is consistent monitoring with your physician.

"When you're asked by a physician to come back for follow-up, you need to be very reliable, particularly if you've been given non-penicillin therapy. Report back to your doctor quickly if your sores don't heal," Lukehart.

More information

The U.S. Centers for Disease Control and Prevention explains what syphilis is and how to prevent the infection.

Botox Stops Lethal Saliva Buildup in Infant

September 21, 2005 08:41:05 PM PST
Botox, famous for erasing the wrinkles of the beauty-conscious, has recently saved a severely ill baby from undergoing tracheotomy to drain excess saliva from his lungs.

In what doctors say is the first time Botox has been used on such a young patient, a Montreal otolaryngologist eight months ago injected Botox into the salivary gland of a one-month-old whose saliva was accumulating in his lungs and constricting his breathing.

Within 10 days of the injection, the baby was taken off the ventilator he had needed to breathe, and is now at home and doing very well, reported Dr. Sam Daniel, who is the doctor who performed the procedure and director of the Saliva Management Clinic at Montreal Children's Hospital.

"I had enough experience and confidence in doing this procedure, but it wasn't an easy decision to make [on such a young child]," Daniel said. "There is scant literature on the topic, very few guidelines and no follow-up."

Yet, he said, the situation facing the baby was dire. Suffering from a rare genetic disorder called Charge Syndrome, the baby had multiple health problems, including possible blindness, and was on a ventilator because of the saliva buildup in his lungs. The normal procedure to treat the excess saliva is a tracheotomy, a surgery where a tube is placed permanently in the throat so that saliva can be regularly suctioned from the lungs by a machine attached to the tube.

The young parents, overwhelmed by their son's multiple health problems and the risks of surgery, considered withdrawing care from the baby rather than have him undergo the invasive surgery.

Following discussions with the parents, pastors at their church, the ethics committee at the hospital and medical experts, Daniel and his colleagues decided to try Botox injections, which had been successful on other children, although he had never performed a procedure on anyone younger than four years old.

"Deep in my heart I knew there was a good chance that it would work, and so we said, 'Let's give it a try,'" he said.

Daniel successfully paralyzed a major salivary gland, but left the smaller glands intact so the baby's mouth was left moist. The infant underwent a second injection two months ago -- Botox's effectiveness lasts for about six months, Daniel said -- and continues doing well.

"This is a procedure that actually has been very commonly done over the last five years, and there are pretty good studies on it, but what is unique is the age of the patient. The difficulty is knowing exactly the dose, as it is toxic, a poison," said Dr. Michael Shohet, an otolaryngologist at Mount Sinai Medical Center in New York City.

"But it's nice to see that we may be able to use it on younger patients which, for obvious reasons we've been reluctant to do because of the dosage," said Shohet, who uses Botox in his own practice to relieve a number of spastic disorders, such as twitching eyelids, and torticollis (also called cervical dystonia), a neurological movement disorder where muscle contractions force the head and neck into abnormal and sometimes painful positions.

While Botox has been approved by the U.S. Food and Drug Administration for various uses since 1989, including eye muscle spasms, torticollis and cosmetic treatments, the agency has not approved the substance for this latest use.

"Botox is very unique and doctors continue to conduct independent research to explore other potential uses," said Caroline Van Hove, a corporate spokeswoman for Allergan, Inc., the Irvine, Calif. manufacturer of Botox.

She said that the company is currently conducting FDA studies to have Botox approved to treat migraine headaches, overactive bladder, and post-stroke spasticity, but are not conducting trials at this time for its use in treating saliva glands.

In the meantime, however, Daniel is continuing to use Botox injections to treat excessive saliva buildup in children suffering from various diseases, such as cerebral palsy or hypotonia, which occurs when muscles are weak and unable to function properly.

"The major benefit is that we have another option to offer kids who have excess saliva secretion necessitating intubation. This is worth a try before offering something more invasive," he said.

More information

The FDA explains how Botox works.