Actinomycotic mycetomas usually respond slowly to treatment with antibiotic
s. In an attempt to hasten clinical resolution, we used a 2-step regimen co
nsisting of an intensive phase of therapy with penicillin, gentamycin and c
o-trimoxazole for 5-7 weeks, followed by maintenance therapy with amoxicill
in and co-trimoxazole. Seven patients were treated, all of whom showed sign
ificant reduction in discharge and swelling after the intensive phase. Main
tenance therapy was continued for 2-5 months after the lesions became compl
etely inactive. Five patients completed maintenance therapy, which was give
n for 6-16 months (mean 10.7 months), and remained free of disease during a
mean post-treatment follow-up period of 6.1 months. The other 2 patients a
lso responded satisfactorily and continue to receive maintenance therapy. S
ide-effects necessitating a modification of the treatment schedule occurred
in 2 patients but reversed on discontinuation of the drugs responsible. Th
is treatment schedule produces a rapid clinical response during the initial
, intensive phase and promotes compliance with the longer maintenance phase
of treatment necessary to achieve a complete cure.