Brucellosis medical therapy: Difference between revisions

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Latest revision as of 20:44, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Danitza Lukac Vishal Devarkonda, M.B.B.S [3]

Overview

The mainstay of therapy for brucellosis is antimicrobial therapy. The preferred regimen for uncomplicated brucellosis is a combination of Doxycycline and streptomycin. Rifampicin 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.^[1]

Medical Therapy

The mainstay of therapy for brucellosis is antimicrobial therapy:^[2]^[3]^[4]^[5]^[6]^[7]

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.

Antimicrobial therapy for Brucellosis
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
Complications of brucellosis	Spondylitis Preferred regimen: Doxycycline for 3 months AND Streptomycin for 2 to 3 weeks. 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 Brucella endocarditis Preferred regimen: Doxycyclineaandn 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
Pregnancy	Preferred regimen: Rifampicin 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.
.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/SMZAND Rifampicin 15 mg/kg/day PO for 6 weeks Alternative regimen (2): RifampicinAND an Aminoglycoside
.Post-exposure prophylaxis	Preferred regimen (1): Doxycycline 100mg PO bid for at least 3 weeks Preferred regimen (2): TMP/SMZ 160 mg/800mg PO bid for at least 3 weeks

Reference

↑ Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016
↑ "CDC".
↑ Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 9th, 2017
↑ Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management.". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364
↑ Aygen B, Doganay M, Sumerkan B, et al. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Med Malad Infect 2002; 32:485.
↑ Herrick JA, Lederman RJ, Sullivan B, et al. Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis 2014; 14:520.
↑ Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME; et al. (2007). "Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations.". PLoS Med. 4 (12): e317.

Template:WH Template:WS

[h-1] Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016

[2] "CDC".

[3] Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 9th, 2017

[4] Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management.". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364

[5] Aygen B, Doganay M, Sumerkan B, et al. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Med Malad Infect 2002; 32:485.

[6] Herrick JA, Lederman RJ, Sullivan B, et al. Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis 2014; 14:520.

[7] Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME; et al. (2007). "Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations.". PLoS Med. 4 (12): e317.

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[2]

[3]

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[7]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Brucellosis}}
-{{CMG}}; {{AE}} {{RT}}
+{{CMG}}; {{AE}} {{RT}} {{DL}} {{VD}}
+==Overview==
+The mainstay of [[therapy]] for brucellosis is [[antimicrobial]] therapy. The preferred regimen for uncomplicated brucellosis is a combination of [[Doxycycline]] and [[streptomycin]].  [[Rifampin|Rifampicin]] 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]].<ref name="h">Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016</ref>
 ==Medical Therapy==
-Treatment can be difficult. Doctors can prescribe effective antibiotics. Usually, [[doxycycline]] and [[rifampin]] are used in combination for 6 weeks to prevent reoccuring 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 [[cell (biology)|cell]]s. Mortality is low (<2%), and is usually associated with endocarditis <ref> http://www.cdc.gov/ncidod/dbmd/diseaseinfo </ref>.
+The mainstay of therapy for brucellosis is antimicrobial therapy:<ref>{{Cite web|url=https://www.cdc.gov/brucellosis/treatment/|title=CDC|last=|first=|date=|website=|publisher=|access-date=}}</ref><ref>Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 9th, 2017
+</ref><ref>Young EJ (1995). [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7546364 "Brucellosis: current epidemiology, diagnosis, and management."]. ''Curr Clin Top Infect Dis''. '''15''': 115–28. PMID [http://www.ncbi.nlm.nih.gov/pubmed/7546364 7546364]</ref><ref>Aygen B, Doganay M, Sumerkan B, et al. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Med Malad Infect 2002; 32:485.</ref><ref>Herrick JA, Lederman RJ, Sullivan B, et al. Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis 2014; 14:520.</ref><ref>Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME; et al. (2007). [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18162038 "Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations."]. ''PLoS Med''. '''4''' (12): e317. </ref>
-===Pharmacotherapy===
+* [[Doxycycline]] and [[streptomycin]] are used in combination for 2-3 weeks to [[Prevention (medical)|prevent]] recurring [[infection]].
+* Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months.
-====Acute Pharmacotherapies====
+* The use of more than one [[antibiotic]] is needed for several weeks, due to the fact that the [[bacteria]] incubates within [[cells]].
-The gold standard treatment for adults is daily intramuscular injections of [[streptomycin]] 1 g for 14 days and oral [[doxycycline]] 100 mg twice daily for 45 days (concurrently). [[Gentamicin]] 5 mg/kg by [[intramuscular injection]] once daily for 7 days is an acceptable substitute when streptomycin is not available or difficult to obtain.<ref>{{cite journal | title=Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans | year=2006 | author=Roushan MRH, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA | journal=Clin Infect Dis | volume=42 | issue=8 | pages=1075&ndash;80 }}</ref>
+{| class="wikitable"
-Another widely used regimen is doxycycline plus rifampin twice daily for at least 6 weeks. This regimen has the advantage of oral administration.
+! colspan="2" |Antimicrobial therapy for Brucellosis
-A triple therapy of doxycycline, together with [[rifampin]] and [[cotrimoxazole]] has been used succefully to treat neurobrucellosis. <ref>{{cite journal | title= Neurobrucellosis: Clinical and therapeutic features | year=1992 | author=McLean DR, Russell N, Khan MY | journal=Clin Infect Dis | volume=15 | pages=582&ndash;90 }}</ref>
+|-
-Doxycycline is able to cross the blood-brain barrier, but requires the addition of two other drugs to prevent relapse. Ciprofloxacin and co-trimoxazole therapy is associated with an unacceptably high rate of relapse.
+|'''Uncomplicated brucellosis in adults and children ≥8yrs of age'''
+|
-In brucellic endocarditis surgery is required for an optimal outcome.
+* 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
-Even with optimal antibrucellic therapy relapses still occur in 5-10 percent of patients with Malta fever.
+* Alternative regimen (2): [[Gentamicin]] 5mg/kg/day IV/ IM  for 7-10 days  {{and}} [[Rifampicin]] 600–900 mg/day PO for six weeks
-Experiments have shown that cotrimoxyzol and rifampin are both safe drugs to use in treatment of pregnant women who have Brucellosis.
+|-
+|'''Complications of brucellosis'''
-===Antimicrobial Regimen===
+|
-:* '''Brucellosis treatment '''<ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>,<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+* '''Spondylitis'''
-::* 1.'''Uncomplicated brucellosis in adults and children ≥8yrs of age'''
+:* Preferred regimen: [[Doxycycline]] for 3 months AND [[Streptomycin]] for 2 to 3 weeks.
-:::* Preferred regimen: [[Doxycycline]] 100 mg  PO bid for 6 weeks {{and}} [[Streptomycin]] 1 g/day IM  for  2-3 weeks
+* '''Neurobrucellosis'''
-:::* Alternative regimen (1): [[Doxycycline]] 100 mg/day PO for six weeks {{and}} [[Gentamicin]] 5mg/kg IM  for 7-days
+:* 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
-:::* Alternative regimen (2): [[Gentamicin]] 5mg/kg/day IV/ IM  for 7-10 days  {{and}} [[Rifampicin]] 600–900 mg/day PO for six weeks
+* '''Brucella endocarditis'''
-::* 2. '''Complications of brucellosis'''
+:* Preferred regimen: [[Doxycycline]]<nowiki/>aandn [[Aminoglycoside]] for at least 8 weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
-:::* 2.1 '''Spondylitis'''
+:* Note: [[Rifampicin]] or [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate [[cell]] membranes
-::::* Preferred regimen:[[ Doxycycline]] for 3 months  {{and}} [[Streptomycin]] for 2 to 3 weeks.
+|-
-:::* 2.2 '''Neurobrucellosis'''
+|'''Pregnancy'''
-::::* 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: [[Rifampin|Rifampicin]] 900 mg PO qd for 6 weeks
-::::* 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: 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]].
-::::* Note: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes
+|-
-::* 3. '''Pregnancy'''
+|.'''For children < 8 yrs of age'''
-:::* 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.
+* 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
-::* 4.'''For children < 8 yrs of age'''
+* Preferred regimen (2): [[Gentamicin]] 5 mg/kg/day IM/ IV q24h for 7-10 days
-:::* 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
+* Alternative regimen (1): [[TMP/SMZ]]AND [[Rifampicin]] 15 mg/kg/day PO for 6 weeks
-:::* Preferred regimen (2): [[Gentamicin]] 5 mg/kg/day IM/ IV q24h for 7-10 days
+* Alternative regimen (2): [[Rifampicin]]AND an [[Aminoglycoside]]
-:::* Alternative regimen (1): [[TMP/SMZ]] {{and}} [[Rifampicin]] 15 mg/kg/day PO for 6 weeks
+|-
-:::* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
+|.'''Post-exposure prophylaxis'''
+|
+* Preferred regimen (1): [[Doxycycline]] 100mg PO bid for at least 3 weeks
+* Preferred regimen (2): [[TMP/SMZ]] 160 mg/800mg PO bid for at least 3 weeks
+|}
 ==Reference==
 {{reflist|2}}
-[[Category:Infectious Disease Project]]
-[[Category:Needs overview]]
-[[Category:Bacterial diseases]]
-[[Category:Occupational diseases]]
-[[Category:Zoonoses]]
-[[Category:Infectious disease]]
-[[Category:Biological weapons]]
-[[Category:Disease]]
 {{WH}}
 {{WS}}
+[[Category:Disease]]
+[[Category:Up-To-Date]]
+[[Category:Pulmonology]]
+[[Category:Hepatology]]
+[[Category:Rheumatology]]
+[[Category:Nephrology]]
+[[Category:Emergency medicine]]
+[[Category:Infectious disease]]

Brucellosis medical therapy: Difference between revisions

Latest revision as of 20:44, 29 July 2020

Overview

Medical Therapy

Reference

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