 |
|
Treatment of Q Fever Endocarditis
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.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
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
Activity of Telithromycin against Thirteen New Isolates of C. burnetii Including Three Resistant to Doxycycline
ROLAIN et al.
Ann. N. Y. Acad. Sci. 2005;1063:252-256.
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
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
|
