The effectiveness of long-acting penicillin (penidur) in preventing recurrencies of dermatolymphangioadenitis (DLA) and controlling skin, deep tissues, and lymph bacterial flora in patients with filarial lymphedema

Dermatolymphangioadenitis (DLA) is a common and serious complication of so-called“filarial” and bacterial non-filarial lymphedema of the limb, affecting skin, lymphatics andlymph nodes. In our previous studies, we demonstrated that more than 60% of patientsrevealed presence of bacterial isolates in deep tissues, tissue fluid and lymph from thelymphedematous limbs. The question remained open whether elimination or suppression ofbacteria dwelling in lymphedematous tissues by administration of low doses of penicillin forlong time periods would prevent recurrence of DLA attacks. In this study, weretrospectively evaluated a self/community-selected group of patients with lymphedema ofthe lower limbs with respect to the efficacy of long-acting penicillin in preventing episodesof DLA. There were no microfilariae or anti-filarial antibodies detected in the investigatedgroup. The questions we asked were: a) how effective is the benzathine penicillin inpreventing recurrences of DLA attacks and b) how does its long-term administrationinfluence the bacterial spectrum of leg skin, deep tissues, lymph and lymph nodes andsensitivity to antibiotics. Two randomly selected groups of patients, receiving and notreceiving penicillin during the same period of time, were compared. Evidently lowerrecurrence rate of DLA was observed in the treated group (p<0.002). There was increasedprevalence of cocci and gram-positive bacilli with a concomitant decrease of gramnegative bacilli on the foot and calf skin surface. Simultaneously, decreased prevalence ofgram-positive cocci and gram-negative bacilli isolates in limb deep tissues and lymph wasseen. No resistance to penicillin and other tested antibiotics developed in isolates from theskin surface, deep tissues and lymph. We conclude that long-lasting penicillin is effective inpreventing recurrent DLA attacks