CEFTRIAXONE IN THE TREATMENT OF CHRONIC DONOVANOSIS IN CENTRAL AUSTRALIA

Objectives-To determine the effectiveness of intramuscular (IM) ceftri axone sodium in the treatment of chronic donovanosis, and the acceptab ility to patients and staff of supervised outpatient treatment in rura l clinics. Methods-We collected demographic and sexual health data fro m participants using a standard questionnaire, recorded lesions baseli ne diagrams. Treatment consisted of a single daily IM injection of 1 g ceftriaxone diluted in 2 ml of 1% lignocaine. Clinic staff followed p atients for between three and 12 months, enabling the detection of lat e recurrences. Setting-Rural Aboriginal communities in central Austral ia. Participants-The study describes eight women and four men with chr onic donovanosis in detail, and summarises the outcome in 12 additiona l cases. All cases presented with advanced lesions which had failed to heal on the standard oral antibiotic regimens used in the region. Res ults-The mean duration of infection was 3.0 years (SD 1.9 years), and between four and ten courses of antibiotics had been prescribed for si x of the 12 patients. Patients received between 7-26g of ceftriaxone s odium. Clinical improvement was in most lesions, and four healed compl etely without recurrence after a total 7-10g of ceftriaxone. Mild recu rrences responded to further ceftriaxone or short courses of oral anti biotics. Treatment was tolerated, and both patient and compliance high . Conclusion-Donovanosis is an important cause of chronic genital ulce ration in central Australia, and is potentially an important risk fact or for HIV transmission in Aboriginal communities. The pharmacokinetic s and safety profile of ceftriaxone make it a useful and cost-effectiv e agent in the ambulatory management of donovanosis, especially in rem ote communities. Supervised multidrug regimens of two or more long-act ing agents may provide the best answer in donovanosis, administered th rough the existing health care infrastructure.