Search

The analysis of the published experimental and clinical data on chemoprophylaxis and chemotherapy of rickettsiosis and Q fever confirmed the preserved role of doxycycline, the main drug of choice in the treatment of the diseases, then followed chloramphenicol. Macrolides, such as azithromycin and clarithromycin proved to be useful in pediatric practice and the treatment of pregnant women with rickettsiosis. The treatment of acute and chronic Q fever required the use of doxycycline, fluoroquinolobes, co-trimoxazole and hydroxachloroquine in combined therapy. It is concluded that in vivo studies of novel drugs and investigation of prospective macrolides and fluoroquinolones are necessary. Clinical trials of a new glycycline, i.e. tigecycline, which experimentally showed highy strong activity against the Q fever pathogen, should be accelerated.

Information about changes in the modern taxonomy of intracellular bacteria conditionally united within the nomination of "Rickettsioses" is presented in the paper. Due to a total hobby related with keeping home animals (pets), cats and dogs, apart from the cattle, joined the natural ecological cycles of rickettsioses stimulation. The morbidity of rickettsioses of the acaroid group has been persistently growing; like in case with other pathologies (Lyme's disease) involving the acaroid transfer factor, its obvious "urbanization" is pronounced. Absolute and relative morbidity indices in respect to rickettsioses, which are epidemiologically important for Russia, are presented. The modern knowledge database concerning the rickettsioses makes it possible to control the epidemic process for this infection category. It is noteworthy, that Prowazek's rickettsiosis of its both forms (i.e. the epidemic and relapsing ones), which does not have an independent cycle of circulation of its stimulator in wild nature, and unlike the acaroid group rickettsioses, turned into a socially controllable infection. It will be totally eliminated, during 10-15 years, both in Russia and the CIS countries. The practitioners are well supplied with a variety of drugs of tetracycline and fluorine-quinol groups, which makes it possible to arrest the infection process in patients rapidly and effectively and to prevent the lethal cases. A low incidence rate of rickettsioses, including Q fever, within the general infection morbidity, and taking into consideration the availability of methods for effective therapy and prevention, makes one consider a comprehensive vaccination against the discussed group of infections to be irrational. Obviously, such vaccination must be still applied in respect to a limited number of persons from among high-risk groups and for two or three varieties of rickettsioses only (i.e. Prowazek's rickettsioses, Rocky Mountain spotted fever and Q fever). Live vaccines, obtained on the basis of attenuated and recombined strains (which have a full-scale set of specific antigens), are recommended.

Comparative chemotherapeutic efficacy of doxycycline administered orally or parenterally was studied on a model of experimental Q fever in guinea pigs and albino mice. The advantage of the parenteral use of the antibiotic was observed only in the treatment of the albino mice. Optimization of the doses and time of doxycycline use providing the maximum therapeutic effect and the required levels of the complement binding antibodies was achieved with employing the multifactorial analysis.

Multifactorial analysis of the combined use of rifampicin and an immunomodulator of the microbial origin, such as peptidoglycan, was performed on a model of experimental Q fever in albino mice. On the basis of the experimental results, statistic polynomial models describing the weight of the murine spleens and the titers of the complement-binding antibodies were designed. It was shown that the action of the immunomodulator and antibiotic was highly synergistic with respect to the chemotherapeutic activity and antibody titers. The preventive use of the immunomodulator yielded a 30-fold decrease in a rifampicin therapeutic dose. The use of the immunomodulator also provided a pronounced immunomodulating effect with respect to humoral immunity. Nomographs for optimizing the dose-time parameters of the antibacterial and immunomodulating therapy were plotted.