Doxycycline

Azithromycin + contact tracing

Doxycycline

Doxycycline is metabolized in the liver and excreted through the bile and not via kidney and hence it is not nephrotoxic.

Ref: KDT, 6th Edition, Pages 713, 721, 734; Drug Injury: Liability, Analysis and Prevention, 2nd Edition, Page 438

Doxycycline – antibiotic of choice for adults only single dose suffices.

Non gonococcal urethritis is most commonly caused by Chlamydia trachomatis and ureaplasma urealyticum. Tetracycline is the drug of choice. Doxycycliine can be used as an alternative. Erythromycin can be used in case of tetracycline resistance.

Less common causes include staphylococcus aureus, gam negative rods, candida albicans, trichomonas vaginalis etc.

Ref: Sexually Transmitted Diseases By Sehgal, 4th Edition, Page 25-7

For mycoplasma tetracyclines are the drugs of choice (doxycycline 100 mg 2 times a day for 10 to 14 days).

Erythromycin, Azithromycin and Fluroquinolones can also be used.

Tetracyclines are contraindicated in pregnancy, therefore erythromycin or spiramycin can be used.

Srub typhus patients presents with high fever, eschar, regional lymphadenopathy. It is treated with:

• DOC: Oral doxycycline 100 BD for 7-14 days
• Alternatives, Azithromycin 500 for 3 days or chloramphenicol

Ref: Harrison, Edition-18, Page.

Ans. is ‘a’ i.e., Doxycycline; ‘b’ i.e., Streptomycin

Ans. is ‘b’ i.e., Doxycycline

Ans. is ‘b’ i.e., Doxycycline

o Photodermatitis is caused by demeclocycline (max) and doxycycline.

Ans. is ‘b’ i.e., Doxycycline

A i.e. Doxycycline

Ans. is ‘c’ i.e., Doxycycline 

o Main treatment of cholera is only rapid and adequate replacement of fluids, electrolytes and base. Although not necessary for cure, the use of an antibiotic to which the organism is susceptible will diminish the duration and volume of fluid loss and will hasten clearance of organism from the stool. Single dose doxycycline is the drug of choice for adults (except pregnant women).

Ans. is ‘a’ i.e., Doxycyline 300 mg OD 

Ans:D.)All of the above.

Inguinal Bubo.

• Inguinal and femoral buboes are localised enlargements of the lymph nodes in the groin area, which are painful and may be fluctuant.
• They are frequently associated with lymphogranuloma venereum and chancroid..

Lymphogranuloma venereum (LGV)

• It is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis.
  • Inoculation at the mucous lining of external sex organs (penis and vagina) can lead to the inguinal syndrome named after the formation of buboes or abscesses in the groin (inguinal) region where draining lymph nodes are located.
• Primary stage:LGV may begin as a self-limited painless genital ulcer that occurs at the contact site 3–12 days after infection.
• The secondary stage most often occurs 10–30 days later.
  • The infection spreads to the lymph nodes through lymphatic drainage pathways.
  • The most frequent presenting clinical manifestation of LGV among malesis unilateral (in 2/3 of cases) lymphadenitis and lymphangitis, often with tender inguinal and/or femoral lymphadenopathy .
  • Lymphangitis of the dorsal penis may also occur and resembles a string or cord.
  • If the route was anal sex the infected person may experience lymphadenitis and lymphangitis and proctitis.
  • In females, cervicitis, perimetritis, or salpingitis may occur as well as lymphangitis and lymphadenitis in deeper nodes.
• Treatment involves antibiotics(Tetracycline/Doxycycline,Erythromycin/Azithromycin) and may involve drainage of the buboes or abscesses by needle aspiration or incision.

Chancroid

• Chancroid is a sexually transmitted disease caused by the fastidious Gram-negative streptobacillus Haemophilus ducreyi.
• H. ducreyi enters skin through microabrasions incurred during sexual intercourse. A local tissue reaction leads to development of erythomatous papule, which progresses to pustule in 4–7 days. It then undergoes central necrosis to ulcerate.
• Painful lymphadenopathy occurs in 30 to 60% of patients.
• Treatment is a single oral dose (1 gram) of azithromycin, or a single IM dose of ceftriaxone, or oral erythromycin for seven days.

Ans. b. Topical retinoic acid + Oral doxycycline

A I9-year-old male presents with several comedones, papules and pustules on face and trunk. This is a case of inflammatory acne with comedones and appropriate drug of choice for this patient is topical retinoic acid with oral doxycycline.

Ans. is ‘d’ i.e., Doxycycline