Granuloma Inguinale: Next-Line Treatment When Azithromycin Has Not Achieved Complete Healing
This protocol applies to granuloma inguinale (donovanosis) in the specific situation where initial therapy with azithromycin has been given but complete healing of the genital ulcers has not been achieved by the three-week reassessment point.
Previous Line — Failure Condition
Prior therapy: Azithromycin
Trigger for escalation: Failure to achieve complete healing of the genital ulcers when reassessed at three weeks.
Trigger for escalation: Failure to achieve complete healing of the genital ulcers when reassessed at three weeks.
Next-Line Approach
When azithromycin has not produced complete healing at three weeks, the protocol moves to an alternative oral antibiotic from a different drug class. The full agent selection and decision algorithm are available in the structured protocol below.
Clinical Goal
Complete healing of the genital ulcers