Evaluation of Penicillin in the Treatment of Yaws

Final Report

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An analysis of the results of treatment of 500 cases of primary and secondary yaws infections with penicillin, in aqueous solution and in oil with beeswax, is presented. Follow-up clinical and serologic observations were made on 446 of these patients for varying lengths of time up to 12 months. Three hundred and twenty (71.7 per cent) were followed for a period of 10 to 12 months after treatment.

Clinical response to treatment was uniformly excellent, but serologic response was not. Only 16.6 per cent of the 446 patients were considered to show “apparent cure.” An additional 75.1 per cent showed “satisfactory progress”, totaling 91.7 per cent. The remaining 8.3 per cent of the patients showed “unsatisfactory progress.” In the latter group were included cases of “reinfection”, “clinical relapse”, and “serologic relapse.”

The per cent of “apparent cures” was higher, 26.7, in the group of hospitalized patients treated over a four-day period with penicillin in aqueous solution than in the two groups treated with penicillin in oil with beeswax on an ambulatory basis over two days, 11.0, and one day, 6.4. However, there was a correspondingly higher proportion of cases showing “satisfactory progress” in the latter two groups of patients so that when one combines cases of “apparent cure” with those showing “satisfactory progress”, the total per cent is almost identical in the three groups of patients, 90.2, 92.9, and 92.8, respectively.

It is appreciated that follow-up observations over a period of 10 to 12 months after treatment are not sufficient to permit a comprehensive evaluation of the efficacy of penicillin in the treatment of yaws. Also, it is not possible to make a strict comparison of the results of treatment of penicillin in aqueous solution with penicillin in oil with beeswax, because of the difference in treatment schedules employed. However, it is felt that penicillin is probably the present-day drug of choice in the treatment of yaws, and that penicillin in oil with beeswax is of considerable public health value in countries such as Haiti where large numbers of patients must be treated on an ambulatory basis in rural clinics. Its use can be expected to successfully control cutaneous lesions and therefore prevent the spread of infection.

Author Notes

Rye, New York.

Assistant in Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland.

New York, New York.

Los Angeles, California.