Antibiotics in the Tropics: Antibacterial Therapy with Limited Resources

336 Pages·1988·14.24 MB·English

by  Dr. med. Sabine Enenkel

S. Enenkel W. Stille
Antibiotics
in the Tropics
Antibacterial Therapy with Limited Resources
With 16 Figures and 132 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Dr. med. Sabine Enenkel
Departme~t of Pediatrics
Professor Dr. Wolfgang Stille
Department of Internal Medicine
University Hospital,
Johann Wolfgang Goethe-UniversiUit,
Theodor-Stern-Kai 7, 6000 Frankfurt/Main 70, FRG
ISBN-13: 978-3-540-18683-0 e-ISBN-13: 978-3-642-73276-8
001: 10.1007/978-3-642-73276-8
Library of Congress Cataloging-in-Publication Data. Enenkel, S. (Sabine), 1957-.
Antibiotics in the tropics. Includes bibliographies and index. 1. Bacterial diseases -
Developing countries - Chemotherapy. 2. Antibiotics - Developing countries. 3. Tropical
medicine. I. Stille, W. (Wolfgang) II. Title. [DNLM: 1. Antibiotics - therapeutic use.
2. Bacterial Infections - drug therapy. 3. Tropical Medicine. QV 350 E56a]
RC115.E54 1988 616.9'2061 87-37652
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© Springer-Verlag Berlin Heidelberg 1988
The use of registered names, trademarks, etc. in this publication does not imply, even in the
absence of a specific statement, that such names are exempt from the relevant protective
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Product Liability: The publisher can give no guarantee for information about drug dosage
and application thereof contained in the book. In every individual case the respective user
must check its accuracy by consulting other pharmaceutical literature.
2119/3140-543210
Preface
International textbooks on infectious diseases and antibacterial
chemotherapy are usually written for readers in North America
and Europe. In many ways, they are not appropriate for the prob
lems encountered in developing countries. This book, in contrast,
intends to define the rules of antibacterial chemotherapy practised
under conditions of limited resources. It is meant for everyone con
cerned with the use of antibiotics in developing countries, includ
ing doctors, medical assistants, pharmacists, officials in health mio
isteries, and medical students.
Throughout the book, treatment recommendations are made for
antibiotics from the WHO list of essential drugs.1 For example, em
phasis has therefore been put upon chloramphenicol as a stable,
unexpensive and widely available oral agent suitable for the treat
ment of severe bacterial infections like septicemia and meningitis.
So-called "international chemotherapy" with modem cephalospor
ins and acylaminopenicillins has been outlined for comparison.
Since it is the aim of the book to base treatment recommenda
tions on data from developing countries, many data on the etiology
of common bacterial infections in developing countries have also
been included. Most of the data are from African, English-speak
ing developing countries, but references have been made to the lit
erature on South East Asia, India or Papua New Guinea, where
appropriate. On the other hand, pertinent data were not available
in every instance, so that several statements and recommendations
had to be made as "best guess". The authors are aware of these
imperfections and will welcome comments from the readers.
The authors are very grateful to the Springer-Verlag for the help
and support in the production of this book.
Frankfurt/Main, March 1988 S. Enenkel, W. Stille
1 WHO Expert committee (1983) The use of essential drugs. Tech Rep Ser
No. 685, WHO, Geneva.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1
Part 1. Principles ofA ntibiotic Therapy
1 The Range ofA ntibiotics Available . . . . . 5
General Principles of Antibiotic Therapy -
The WHO List of Essential Drugs . . . . .. 5
The Main Antibiotics of the WHO List ... 10
Classical Penicillins . . . . . . . . . . . . . . . . . . 10
Benzylpenicillin (Penicillin G) and Its Oral Form
Phenoxymethylpenicillin .............. 10
Repository Penicillins . . . . . . . . . . . . . . . . 11
Ampicillin . . . . . . . . . . . . . . . . . . . . . . . . 11
Penicillinase-Stable Penicillins. . . . . . . . . . . . . 12
Tetracyclines. . . . . . . . . . . . . . . . . . . . . . . .. 12
Chloramphenicol . . . . . . . . . . . . . . . . . . . . .. 13
Co-Trimoxazole and Sulfonamides . . . . . . . . . . .. 14
Co-Trimoxazole ..................... 14
Sulfonamides . . . . . .. ..... . . . . . . . .. 15
Aminoglycosides . . . . .. ...... . . . . . . .. 15
Gentamicin. ...... . . . . . . . . . . . . .. 16
Erythromycin . . . . . . .. .. . . . . . . . . . . .. 17
Metronidazole. . . . . . . . .. . . . . . . . . . . .. 17
Nitrofurantoin. . . . . . . . . . . . . . . . . . . . . . 18
Rifampicin. . . . . . . . . . . . . . . . . . . . . . . . 19
Further Antibiotics and Therapeutic Groups
(Not on WHO List) . . . . . . . . . . . . ... . 19
Quinolones .......... .......... . 19
Old Quinolones. . . . . .. ........... . 20
Modern Quinolones . . . . . . . . . . . . . . . 20
Acylaminopenicillins . . . . . . . . 21
Cephalosporins . . . . . . . . . . . 21
Other Antibiotics . . . . . . . . . . . . . . . 23
Vancomycin. . . . . . . . . . . . . . . . . 23
Clindamycin . . . . . . . . . . . . . . . . 23
Imipenem . . . . . . . . . . . . . . . . . . . . . . . .. 24
Amoxicillin/Clavulanic Acid (Augmentin) . . . . . . .. 24
VIII Contents
2 Choice ofA ntibiotics 26
3 Bacterial Resistance in Developing Countries 34
4 Administration ofA ntibiotics. 39
Topical Administration 40
5 Dosage ofA ntibiotics. 41
Recommended Doses . 41
Duration of Treatment 41
Tolerance . . . . . . . . 43
Dosage in Neonates, Infants, and Children 43
Pediatric Dosage . . . . . . . . . . . . 43
Premature and Full-Term Neonates and Infants
During First Month of Life . . 44
6 Side Effects and Contra indications 45
Toxic Side Effects . . . 45
Allergic Side Effects . . 47
Biological Side Effects 48
7 Combinations ofA ntibiotics 49
8 Costs ofA ntibiotics . . . . . 51
Part II. Treatment of Infections and Infectious
Diseases
9 Septicemia 55
10 Infective Endocarditis. 71
Streptococcal Endocarditis 75
Endocarditis Due to Pneumococci or
Group A Streptococci . . . . 76
Enterococcal Endocarditis . 76
Staphylococcal Endocarditis 77
Staphylococcus Aureus . . 77
Staphylococcus Epidermidis . 78
Endocarditis Due to Gram-Negative Bacteria. 78
Culture-Negative Endocarditis 78
Prevention of Endocarditis 79
11 Purulent Pericarditis . . . 81
Contents IX
12 Infections of the Central Nervous System. 83
Bacterial Meningitis . 83
Brain Abscess . . . · 101
Subdural Empyema . · 102
13 Infections of the Respiratory Tract .... · 105
Acute Respiratory Infections in Childhood · 105
Common Cold . . . . . · 108
Tonsillitis, Pharyngitis . . . . . . . . . . . . · 108
Rheumatic Fever ............ . .109
Peritonsillar Abscess, Retropharyngeal Abscess,
and Ludwig's Angina · 110
Croup .................... . · 110
Acute Bronchitis . . . . . . . . . . . . . . . · 111
Acute Exacerbation of Chronic Bronchitis · 111
Bronchiolitis . . . . . . . . . . . . . . . . . · 112
. Pneumonia . . . . . . . . . . . . . . . . . . · 112
Treatment of Community-Acquired Pneumonia · 119
Treatment of Special Types of Pneumonia · 127
Staphylococcal Pneumonia · 127
Measles Pneumonia . . · 127
Klebsiella Pneumonia . . . · 129
Aspiration Pneumonia . . . · 129
Acute Abscess-Forming Pneumonia · 129
Interstitial Pneumonias ...... . .130
Legionnaires'Disease ....... . .130
Secondary, Hospital-Acquired Pneumonias .130
Postoperative Pneumonia . . . . . . . . . . · 131
Postinfluenza Pneumonia . . . . . . . . . . · 131
Efficacy of Antimicrobial Agents in Different Types
of Pneumonia . . . . · 131
Empyema ...... . · 131
Chronic Lung Abscess .134
Bronchiectasis . . .134
Whooping Cough · 135
Diphtheria . . . . .136
14 Infections of the Gastrointestinal Tract · 142
Diarrheal Diseases . .142
Appendicitis . . . . . . · 161
Peritonitis ...... . · 163
Pyogenic Liver Abscess · 165
Biliary Tract Infections · 166
X Contents
15 Infections of the Musculoskeletal System . · 170
Osteomyelitis. . .170
Septic Arthritis . · 178
Pyomyositis .. · 183
16 Skin and Wound Infections · 187
Common Bacterial Infections .. · 187
Prophylaxis of Wound Infections · 198
Indications of Prophylaxis . . .203
Modem Rules of Prophylaxis .203
Tetanus .... .205
Gas Gangrene . . . . . . . . . . .206
17 Sexually Transmitted Diseases. .210
Gonorrhea ........... . · 216
Other Sexually Transmitted Diseases · 219
18 Obstetric and Gynecological Infections .222
Bartholinitis . . . . . . . . . .222
Vulvovaginitis in Children .222
Vaginitis, Vulvitis in Adults . .223
Types of Vaginal Disease . . .223
Pelvic Inflammatory Disease .225
Other Obstetric and Gynecological Infections .226
Septic Abortion . .226
Puerperal Sepsis. . . . .226
Mastitis ....... . .227
Pyrexia During Labor .227
19 Genitourinary Infections · 231
Urinary Tract Infections. · 231
Urethritis ........ . .240
Prostatitis, Epididymitis . .240
Acute Epididymitis . . .241
20 Infections of the Ear, Nose, and Throat .243
External Otitis . . . . . . . . .243
Malignant External Otitis .243
Otitis Media . . . . . . . . . .243
Acute Otitis Media . . . . .244
Chronic Suppurative Otitis Media. .244
Mastoiditis . . . . . . . . . . . . . . . .245
Contents XI
Sinusitis ..... .245
Stomatitis. . . . . .247
Viral Stomatitis .247
Candida Stomatitis .247
Necrotizing Ulcerative Gingivitis. .247
Noma (Cancrum Oris) . .248
Osteomyelitis of the Jaw .248
Cervical Lymphadenitis . .249
21 Eye Infections . .... · 251
Ulcerating Blepharitis. · 251
Hordeolum ...... . · 251
Abscess and Cellulitis of Lid .251
Orbital Cellulitis . . . . . . . · 251
Acute Dacryocystitis .... .252
Acute Bacterial Conjunctivitis .252
Ophthalmia Neonatorum. .253
Trachoma ...... . .254
Keratitis ...... . .256
Bacterial Keratitis . · 256
Herpetic Keratitis . · 256
Fungal Keratitis . . · 257
Phlyctenular Keratitis. .257
Measles Keratitis . . . .257
Bacterial Endophthalmitis · 257
22 Salmonella Infections. . . .259
Typhoid Fever . . . . . . . . . . . . . .259
Nontyphoidal Salmonella Infections .262
23 Rickettsial Diseases . . . . . . . . . . · 265
24 Leptospirosis . .269
25 Brucellosis . . · 271
26 Relapsing Fever . . . . . . .274
27 Anthrax .276
28 Plague. .278
29 Listeria Infections. .280
30 Melioidosis . ......... . · 282
31 Nonvenereal Treponematoses .284
XII Contents
32 Mycobacterial Infections . . 285
Tuberculosis . 285
Leprosy. . . . 295
Buruli Ulcer . 299
33 Actinomycosis . 302
34 Nocardiosis . . 303
35 Rare Bacterial Diseases: Bartonellosis, Erysipeloid,
and Ratbite Fever . . 305
36 Fungal Infections . . 306
Dermatophyte Infections . 307
Tinea Capitis . . . . . . . . 307
Fungal Infections of the Nails . 308
Tinea Versicolor . . . . . 309
Candida Infections .. . 309
Genital Candidiasis . . 309
Oral Candidiasis .. . 310
Candida Esophagitis . 310
Candida Enteritis . . . 310
Candida Pneumonia . 310
Candida Infections of the Urinary Tract . 311
Candida Septicemia. . . . . . . . . . . . 311
Candida Infections of the Skin. . . . . . 311
Chronic Mucocutaneous Candidiasis . . 311
Cryptococcal Infection . 312
Infections by Molds . . . 312
Aspergillus Infections . 312
Mycetoma . . . . . 313
Chromomycosis . . 313
Rhinosporidiosis. . 314
Sporotrichosis . . . 314
Subcutaneous Phycomycosis . 314
Rhinoentomophthoromycosis . 314
Histoplasmosis. . . . . . . 315
Blastomycosis . . . . . . . 315
Paracoccidioidomycosis . . 316
Coccidioimycosis . . . . . 316
Systemic Treatment of Fungal Infections . 316
37 Treatment ofA IDS . . . . . . . . . . . . . 319
Subject Index ........................... 322