Brucellosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
The mainstay of therapy for brucellosis is antimicrobial therapy. The preferred regimen for uncomplicated brucellosis is a combination of Doxycycline and Streptomycin. Rifampin is the drug of choice for brucellosis in pregnancy. For children less than 8 years of age, the preferred regimen is either Gentamycin or a combination of Trimethoprim-sulfamethoxazole and Streptomycin.
Medical Therapy
Treatment can be effective with antibiotics. Usually, Doxycycline and Streptomycin are used in combination for 2-3 weeks to prevent recurring infection. Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months. The use of more than one antibiotic is needed for several weeks, due to the fact that the bacteria incubates within cells. Mortality is low (<2%), and is usually associated with endocarditis[1].
Antimicrobial Regimen
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- 1.Uncomplicated brucellosis in adults and children ≥8yrs of age
- Preferred regimen: Doxycycline 100 mg PO bid for 6 weeks AND Streptomycin 1 g/day IM for 2-3 weeks
- Alternative regimen (1): Doxycycline 100 mg/day PO for six weeks AND Gentamicin 5mg/kg IM for 7-days
- Alternative regimen (2): Gentamicin 5mg/kg/day IV/ IM for 7-10 days AND Rifampicin 600–900 mg/day PO for six weeks
- 2. Complications of brucellosis
- 2.1 Spondylitis
- Preferred regimen:Doxycycline for 3 months AND Streptomycin for 2 to 3 weeks.
- 2.2 Neurobrucellosis
- Preferred regimen: Ceftriaxone 2 mg IV q12h for 1 month AND Doxycycline 100 mg PO bid for 4-5 month AND Rifampicin 600–900 mg/day PO for 4-5 month
- 2.3 Brucella endocarditis
- Preferred regimen: Doxycycline AND an Aminoglycoside for at least 8 weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
- Note: Rifampicin OR Trimethoprim/sulfamethoxazole are used for their ability to penetrate cell membranes
- 3. Pregnancy
- Preferred regimen: Rifampin 900 mg PO qd for 6 weeks
- Note: Adding Trimethoprim-sulfamethoxazole can be considered, but this option should probably be avoided preceding the 13th week and after the 36th week of gestation because of concern about teratogenicity and kernicterus.
- 4.For children < 8 yrs of age
- Preferred regimen (1): TMP/SMZ 8/40 mg/ kg/day PO bid for 6 weeks AND Streptomycin 30 mg/kg/day IM q24h for 3 weeks
- Preferred regimen (2): Gentamicin 5 mg/kg/day IM/ IV q24h for 7-10 days
- Alternative regimen (1): TMP/SMZ AND Rifampicin 15 mg/kg/day PO for 6 weeks
- Alternative regimen (2): Rifampicin AND an Aminoglycoside
Reference
- ↑ http://www.cdc.gov/ncidod/dbmd/diseaseinfo
- ↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.