***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Human subjects were infected with Haemophilus ducreyi . All subjects developed papules and were r and omized to treatment with a single dose of azithromycin ( 1 g ) or ciprofloxacin ( 500 mg ) . At weekly intervals , volunteers were reinoculated with H. ducreyi , and drug concentrations were measured in peripheral blood mononuclear cells ( P BMC ) . When papules developed , the subjects were treated with antibiotics and dismissed from the study . Eight of the ciprofloxacin-treated subjects developed papules 1 week after the initial treatment , and the ninth subject developed disease 2 weeks after treatment . The 9 azithromycin-treated subjects developed papules 4 - 10 weeks ( mean , 6.8 ) after the initial treatment ( P < .001 ) . Azithromycin was detected in P BMC for 3 - 6 weeks ( mean , 4 ) . Pre- and posttreatment lesions had histology typical of experimental chancroid or were culture positive .  Azithromycin prevents experimental chancroid for nearly 2 months . These findings have implication s for strategies to prevent chancroid Background and Objectives : Cotrimoxazole has traditionally been used as first drug for treatment of chancroid in India . With reports of increasing resistance to the drug , this study was conducted to compare treatment response of clinical chancroid between ciprofloxacin , 500 mg twice daily for 3 days , erythromycin , 500 mg four times daily for 7 days , and double‐strength cotrimoxazole ( trimethoprim 160 mg + sulfamethoxazole 800 mg ) , twice daily for 7 days . Study Design : Forty‐six patients with a clinical diagnosis of chancroid were r and omly divided into 3 groups . Sixteen patients received ciprofloxacin , whereas 15 each received erythromycin and cotrimoxazole . Patients were seen on day 7 , 14 , and if needed day 21 . Clinical response was noted in terms of cure , improvement , or failure . Results : Excellent response was observed to both ciprofloxacin and erythromycin therapy with cure rates of 93.7 % and 93.3 % , respectively . Improvement was observed in 6.7 % cases in both groups . There were no failures with either ciprofloxacin or erythromycin . Poor response to  cotrimoxazole therapy was observed with 53.3 % cure rates and a high failure rate of 46.7 % . Conclusion : Ciprofloxacin and erythromycin are equally effective in chancroid . Ciprofloxacin is better in terms of dosage schedule , duration of treatment , and low cost . Cotrimoxazole should be discontinued as drug of choice because of high failure rates A r and omized , double-blind , placebo-controlled clinical trial was conducted in Nairobi , Kenya , to compare single-dose ciprofloxacin with a 7-day course of erythromycin for the treatment of chancroid .  In all , 208 men and 37 women presenting with genital ulcers clinical ly compatible with chancroid were enrolled . Ulcer etiology was determined using culture techniques for chancroid , serology for syphilis , and a multiplex polymerase chain reaction for chancroid , syphilis , and herpes simplex virus ( HSV ) . Ulcer etiology was 31 % unmixed chancroid , 23 % unmixed syphilis , 16 % unmixed HSV , 15 % mixed etiology , and 15 % unknown . For 111 participants with chancroid , cure rates were 92 % with ciprofloxacin and 91 % with erythromycin . For all study participants , the treatment failure rate was 15 % , mostly related to ulcer etiologies of HSV infection or syphilis , and treatment failure was 3 times more frequent in human immunodeficiency virus-infected subjects than in others , mostly owing to HSV infection . Ciprofloxacin is an effective single-dose treatment for chancroid , but current recommendations for empiric therapy of genital ulcers may result in high treatment failure due to HSV infection One hundred and thirty six patients with chancroid were treated with four different treatment regimens ; ( A ) Sulphaphenazole 1 g 12 hourly by mouth x 10 days ( B ) Inj streptomycin 1 g intramuscularly daily with sulphaphenazole 1 g 12 hourly orally x 10 days ; ( C ) trimethoprim 200 mg 12 hourly by mouth x 7 - 10 days , and ( D ) erythromycin 500 mg 6 hourly orally x 7 - 10 days . Cure rates of 9 % with sulphaphenazole alone , 48 % with streptomycin and sulphaphenazole combination , 93 % with trimethoprim and 100 % with erythromycin were obtained . Sulphaphenazole alone or in combination with streptomycin were thus inferior in the treatment of chancroid . There is need for modification of treatment regimens recommended for chancroid in the textbooks of dermatology and venereology . Trimethoprim can be recommended as first line of treatment for chancroid in developing countries like India where resistance to trimethoprim is uncommon and erythromycin is suggested as a second line of therapy because by that time syphilis can be easily ruled out We conducted a r and omized , unblinded , prospect i ve study design ed to determine the efficacy of single-dose azithromycin for the treatment of chancroid . Men and women 16 years of age and older who had darkfield-negative genital ulcers that were clinical ly suspected to be caused by Haemophilus ducreyi and who attended urban sexually transmitted disease clinics or presented to hospital emergency departments were enrolled in the study . Patients were r and omized to receive 250 mg of ceftriaxone i m or 1 g of azithromycin orally , both given as a single dose . They were followed for up to 23 days after treatment . For 65 patients , cultures were positive for H. ducreyi ; there were 68 patients whose cultures were negative for both H. ducreyi and herpes simplex virus and who had no evidence of syphilis . All 133 patients returned for at least one follow-up visit . At the time of the last follow-up visit , all 32 patients whose cultures were positive for H. ducreyi and who were treated with azithromycin were clinical ly cured . In all 33 culture-positive cases in which ceftriaxone was used , there was either clinical improvement or cure at the time of the patient 's last follow-up visit . In addition , azithromycin and ceftriaxone were equally effective in healing ulcers for which cultures were negative . We conclude that a single 1-g oral dose of azithromycin is as effective as a 250-mg i m dose of ceftriaxone for the treatment of chancroid Background and Objectives Chancroid is endemic in sub-Saharan Africa and enhances the sexual transmission of the human immunodeficiency virus Type 1 ( HIV-1 ) . Azithromycin is an orally absorbed macrolide antibiotic that is active against Haemophilus ducreyi , the causative agent of chancroid , and has pharmacokinetic properties that are suitable for single dosing . Study Design In a r and omized single-blinded study of 127 men presenting to a referral STD clinic with culture proven chancroid , we compared the efficacy of azithromycin , administered as a single 1 g dose , with erythromycin 500 mg given 4 times daily for 7 days . Results : Cure rates were 89 % ( 73 of 82 ) in the azithromycin group and 91 % ( 41 of 45 ) in the erythromycin group . A failure to respond to treatment was associated with HIV-1 seropositivity and a lack of circumcision . Both regimens were well tolerated . Conclusions Azithromycin , given as a single 1 g oral dose , is an effective treatment for chancroid in men , and offers major prescribing advantages over erythromycin Tetracyclines and sulfonamides are no longer effective for the treatment of chancroid in many parts of the world . Rifampin and trimethoprim both possess in vitro activity against Haemophilus ducreyi , the causative agent of chancroid . In a r and omized , controlled study , 22 patients with H. ducreyi-positive genital ulcers received 600 mg of rifampin once daily for three days , and 32 patients received 600 mg of rifampin plus 160 mg of trimethoprim once daily for three days . Both regimens rapidly eradicated H. ducreyi from ulcers , with subsequent healing of ulcers and buboes . Two relapses of ulcers and one therapeutic failure were observed in the rifampin-trimethoprim group , whereas no relapses or failures were noted in the rifampin group . In addition , all of 16 H. ducreyi-negative ulcers responded rapidly to treatment with either regimen . In an uncontrolled , open study , 22 H. ducreyi-positive ulcers were treated with a single dose of rifampin ( 600 mg ) plus trimethoprim ( 160 mg ) . Ulcers and buboes resolved by day 14 in all but one patient . Thus , these short-course and single-dose regimens are effective against chancroid In a r and omized , controlled study , 55 patients with genital ulcerations , culture-positive for Haemophilus ducreyi , were treated with a single intramuscular injection of 2 g spectinomycin . A further 61 patients were treated with a five-day oral course of erythromycin base ( 500 mg , three times daily ) . Treatment failure occurred in seven patients who received spectinomycin ( 13 % ) , whilst no treatment failures were recorded among patients who received erythromycin . This difference in efficacy was statistically significant . In contrast , spectinomycin proved significantly more effective than erythromycin in the treatment of the lymphadenopathy associated with primary chancroid lesions 
    Output:
    
AUTHORS ' CONCLUSIONS At present , the quality of the evidence on the effectiveness and safety of macrolides for treatment of H ducreyi infection in sexually active adults is low , implying that we are uncertain about the estimated treatment effect .
There is no statistically significant difference between the available therapeutic alternatives for the treatment of sexually active adults with genital ulcers compatible with chancroid .
Low quality evidence suggests that azithromycin could be considered as the first therapeutic alternative , based on their mono-dose oral administration , with a similar safety and effectiveness profile , when it is compared with long-term erythromycin use .