A two-step schedule for the treatment of actinomycotic mycetomas

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.