This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (90)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Bacterial Infections  • Alert me on articles by topic  Social Bookmarking   What's this?

Comparison of 2 Regimens Containing Doxycycline and Ofloxacin or Hydroxychloroquine

Didier Raoult, MD, PhD; Pierre Houpikian, MD; Hervé Tissot Dupont, MD; Jean Marc Riss, MD; J. Arditi-Djiane, MD; Philippe Brouqui, MD

Arch Intern Med. 1999;159:167-173.

Background  Q fever endocarditis, caused by Coxiella burnetii, is fatal in 25% to 60% of patients. Currently, treatment with a long-term tetracycline and quinolone regimen for at least 4 years is recommended, although relapses are frequent.

Methods  Between January 1987 and December 1997, the reference treatment of Q fever endocarditis was compared with one of doxycycline and hydroxychloroquine sulfate. Patients were treated by conventional therapy until May 1991 and then by the new regimen. Microimmunofluorescence was used for antibody-level determination for diagnosis and follow-up.

Results  Thirty-five patients were included in the study, 26 males and 9 females. Of 14 patients treated with a doxycycline and quinolone combination, 1 died, 7 relapsed (3 were re-treated and 4 switched to the new regimen), 1 is still being treated, and 5 were considered cured using this regimen only. The mean duration of therapy for cure in this group was 55 months (median, 60 months). Twenty-one patients received the doxycycline and hydroxychloroquine regimen: 1 patient died of a surgical complication, 2 are still being treated, 17 were cured, and 1 is currently being evaluated. Two patients treated for 12 months but none of the patients treated for longer than 18 months relapsed. The mean duration of treatment in this group was 31 months (median, 26 months). No significant differences were observed between the 2 regimens in terms of death, valve surgery, or tolerance. The mortality rate for both regimens in this study was 5%.

Conclusion  Prescription of the doxycycline and hydroxychloroquine combination for at least 18 months allows shortening of the duration of therapy and reduction in the number of relapses.

From the Unité des Rickettsies, Faculté de Médecine, Université de la Mediterranée CNRS (Drs Raoult, Houpikian, Tissot Dupont, and Brouqui); Infectious Disease Units, Hôpital F. Houphouët Boigny (Drs Houpikian and Brouqui) and Hôpital Conception (Dr Tissot Dupont); Ophthalmology Department, Hôpital Timone (Dr Riss); and Toxicology Laboratory, Hopital Salvator (Dr Arditi-Djiane), Marseille, France.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Culture-negative endocarditis: "whatever remains, however improbable, must be the truth"; the importance of asking the right questions!
Kachhia et al.
BMJ Case Reports 2009;2009:bcr1120081288-bcr1120081288.
ABSTRACT | FULL TEXT  

Mutational paths towards increased fluoroquinolone resistance in Legionella pneumophila
Almahmoud et al.
J Antimicrob Chemother 2009;64:284-293.
ABSTRACT | FULL TEXT  

Therapeutic impact of the correlation of doxycycline serum concentrations and the decline of phase I antibodies in Q fever endocarditis
Lecaillet et al.
J Antimicrob Chemother 2009;63:771-774.
ABSTRACT | FULL TEXT  

Q Fever: Epidemiology, Diagnosis, and Treatment
Hartzell et al.
Mayo Clin Proc. 2008;83:574-579.
ABSTRACT | FULL TEXT  

Prevention of malaria in long-term travelers.
Chen et al.
JAMA 2006;296:2234-2244.
ABSTRACT | FULL TEXT  

Epidemiology and antibiotic treatment of infective endocarditis: an update.
Hoen
Heart 2006;92:1694-1700.
FULL TEXT  

Q Fever in the southern california desert: epidemiology, clinical presentation and treatment.
CONE et al.
Am J Trop Med Hyg 2006;75:29-32.
ABSTRACT | FULL TEXT  

Chronic q Fever in the United States.
Karakousis et al.
J. Clin. Microbiol. 2006;44:2283-2287.
ABSTRACT | FULL TEXT  

Correlation between Ratio of Serum Doxycycline Concentration to MIC and Rapid Decline of Antibody Levels during Treatment of Q Fever Endocarditis
Rolain et al.
Antimicrob. Agents Chemother. 2005;49:2673-2676.
ABSTRACT | FULL TEXT  

Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy
Elliott et al.
J Antimicrob Chemother 2004;54:971-981.
ABSTRACT | FULL TEXT  

Both Inducible Nitric Oxide Synthase and NADPH Oxidase Contribute to the Control of Virulent Phase I Coxiella burnetii Infections
Brennan et al.
Infect. Immun. 2004;72:6666-6675.
ABSTRACT | FULL TEXT  

Latent Infective Endocarditis: Epidemiology and Clinical Characteristics of Patients With Unsuspected Endocarditis Detected After Elective Valve Replacement
Shapira et al.
Ann. Thorac. Surg. 2004;78:1623-1629.
ABSTRACT | FULL TEXT  

Coxiella burnetii infection of an aortic graft: surgical view and a word of caution
Georghiou et al.
ICVTS 2004;3:333-335.
ABSTRACT | FULL TEXT  

Antibiotic Susceptibility of Tropheryma whipplei in MRC5 Cells
Boulos et al.
Antimicrob. Agents Chemother. 2004;48:747-752.
ABSTRACT | FULL TEXT  

Q Fever Endocarditis in the United States
Gami et al.
Mayo Clin Proc. 2004;79:253-257.
ABSTRACT  

Simplified Serological Diagnosis of Endocarditis Due to Coxiella burnetii and Bartonella
Rolain et al.
CVI 2003;10:1147-1148.
ABSTRACT | FULL TEXT  

Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue
AYRES et al.
QJM 2002;95:539-546.
ABSTRACT | FULL TEXT  

Q Fever During Pregnancy: Diagnosis, Treatment, and Follow-up
Raoult et al.
Arch Intern Med 2002;162:701-704.
ABSTRACT | FULL TEXT  

Survival of Tropheryma whipplei, the Agent of Whipple's Disease, Requires Phagosome Acidification
Ghigo et al.
Infect. Immun. 2002;70:1501-1506.
ABSTRACT | FULL TEXT  

Infective Endocarditis in Adults
Mylonakis and Calderwood
NEJM 2001;345:1318-1330.
FULL TEXT  

Endocarditis Due to Rare and Fastidious Bacteria
Brouqui and Raoult
Clin. Microbiol. Rev. 2001;14:177-207.
ABSTRACT | FULL TEXT  

Coxiella burnetii Survives in Monocytes from Patients with Q Fever Endocarditis: Involvement of Tumor Necrosis Factor
Dellacasagrande et al.
Infect. Immun. 2000;68:160-164.
ABSTRACT | FULL TEXT  

Q Fever
Maurin and Raoult
Clin. Microbiol. Rev. 1999;12:518-553.
ABSTRACT | FULL TEXT  

Treating Q Fever Endocarditis
JWatch Infect. Diseases 1999;1999:10-10.
FULL TEXT