Actinomycetoma by Actinomadura madurae. Clinical and therapeutic characteristics of 18 cases with two treatment modalities

Abstract

Background: Actinomycetoma due to Actinomadura madurae is susceptible to numerous chemotherapeutic agents, however, the response to those treatments is variable and closely related to several factors.

Objective: We aimed to evaluate the clinical-therapeutic characteristics of patients with actinomycetoma due to Actinomadura madurae with two treatment modalities.

Methods: This was a retrospective study of eighteen patients with a diagnosis of actinomycetoma. The most widely used therapeutic scheme was streptomycin 1 g every third day plus TMP/SMX 800 mg/160 mg/12h, followed by TMP/SMX with DDS 100 mg/day. In six patients (33%), ciprofloxacin 500 mg every 12 h was used instead of DDS.

Results: Conventional scheme achieved clinical and mycological cure in 58% of the cases, improvement in 16%, and 25% of the patients failed to treatment; in the cases treated with ciprofloxacin, clinical and microbiological cure was achieved in 83% of patients and clinical improvement in 16%. The treatment time to achieve clinical and mycological did not have a statistically significant difference (median 10 ± 1.38 vs. 12 ± 4.6).

Conclusion: Treatment based on streptomycin + TMP/SMX with ciprofloxacin was found to be effective in treating patients with actinomycetoma, and comparable to the conventional treatment with DDS in actinomycetoma due to A. madurae with minimal bone involvement.

Keywords: Actinomadura madurae; Actinomycetoma; ciprofloxacin; diamino-diphenyl-sulfone; mycetoma; streptomycin; sulphamethoxazole-trimethoprim.