Association of high T allele frequency of CYP2B6 G516T polymorphism among ethnic south Indian HIV-infected patients with elevated plasma efavirenz and nevirapine

location and similar symptoms after 35 months of follow-up, but refused further diagnostic or therapeutic attempts. Another four patients experienced local infectious complications probably related to the former actinomycosis at 4, 25, 27 and 30 months after the end of treatment, respectively. Treatment duration in 5 of these 6 patients had a length of ,3 months and was significantly shorter than that of the 35 patients with an uneventful follow-up (P1⁄40.001, two-sided Mann–Whitney U-test). According to reviews, the recommended treatment length consists of several weeks of intravenous therapy followed by 6–12 months of oral treatment. Recently, the concept of shorter treatment courses has been introduced, especially for cervicofacial actinomycosis. Case series involving patients with pulmonary actinomycosis, treated exclusively medically with short course regimens, are sparse: a few series with a maximum number of 15 patients showed treatment successes after antibiotic regimens shortened to a median duration of 4–20 weeks; however, follow-up data were often missing or incomplete. – 6 In our series, 24 patients (56%) were treated for ,6 months without prior surgical debulking and with a clinical cure rate of 100%. On the other hand, 10 of 13 patients with evidence of abscess formation or chest wall involvement were treated for .6–14 months because of slow resolution of the radiographic lesions. Six of 41 patients (15%) with complete follow-up data developed either documented or possible recurrence or local complications. These patients received significantly shorter antibiotic courses when compared with the other patients, and duration was below 3 months in five of them. We suggest that antibiotic treatment duration should be individualized, and termination of treatment can probably be considered 1 or 2 months after complete clinical and radiological disease resolution in most patients. However, treatment durations below 3 months in medically treated patients without prior surgical debulking should probably be avoided, as they might be associated with an increased risk of complications. The main limitations of our study are those generally inherent in retrospective analyses. We were not able to calculate the diagnostic accuracy of the applied procedures in detail, and we cannot provide a prospective comparison between different antibiotics and treatment durations. However, due to the sporadic occurrence of actinomycosis, prospective trials might be nearly impossible to perform, and our case series represents the largest report on pulmonary actinomycosis in the recent literature. We conclude that (i) surgical diagnostic procedures can be avoided in the majority of patients by performing transbronchial catheter biopsies and/or transthoracic needle aspiration, (ii) antibiotic treatment with penicillin and alternatively doxycycline is associated with an excellent clinical cure rate despite high rates of penicillin intolerance, and (iii) individual treatment duration can be shortened below the recommended 6–12 months; however, treatment below 3 months in exclusively medically treated patients might be associated with complications during follow-up.