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.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Brucellosis}}
-{{CMG}}; {{AE}} {{RT}} {{DL}}
+{{CMG}}; {{AE}} {{RT}} {{DL}} {{VD}}
 ==Overview==
-The mainstay of [[therapy]] for brucellosis is [[Antimicrobial drug|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]].
+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 effective with [[antibiotics]].
+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
-* [[Doxycycline]] and  [[Streptomycin]] are used in combination for 2-3 weeks to prevent recurring infection.
+</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>
+* [[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.
-* 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.
+* 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.<ref name="b">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref>
+{| class="wikitable"
+! colspan="2" |Antimicrobial therapy for Brucellosis
-===Antimicrobial Regimen===
+|-
-:* '''Brucellosis '''<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><ref name="a">Brucellosis. CDC. http://www.cdc.gov/brucellosis/veterinarians/rb51-reduce-risk.html. Accessed on February 5, 2016</ref>
+|'''Uncomplicated brucellosis in adults and children ≥8yrs of age'''
-::* 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
+* 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 (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
+* 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'''
+|'''Complications of brucellosis'''
-::::* Preferred regimen:[[ Doxycycline]] for 3 months  {{and}} [[Streptomycin]] for 2 to 3 weeks.
+|
-:::* 2.2 '''Neurobrucellosis'''
+* '''Spondylitis'''
-::::* 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
+:* Preferred regimen: [[Doxycycline]] for 3 months AND [[Streptomycin]] for 2 to 3 weeks.
-:::* 2.3 '''Brucella endocarditis'''
+* '''Neurobrucellosis'''
-::::* 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
+:* 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
-::::* Note: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes
+* '''Brucella endocarditis'''
-::* 3. '''Pregnancy'''
+:* 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
-:::* Preferred regimen: [[Rifampin]] 900 mg PO qd  for 6 weeks
+:* Note: [[Rifampicin]] or [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate [[cell]] membranes
-:::* 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'''
+|'''Pregnancy'''
-:::* 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
+* Preferred regimen: [[Rifampin|Rifampicin]] 900 mg PO qd for 6 weeks
-:::* Alternative regimen (1): [[TMP/SMZ]] {{and}} [[Rifampicin]] 15 mg/kg/day PO 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]].
-:::* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
+|-
-::* 5.'''Post-exposure prophylaxis'''
+|.'''For children < 8 yrs of age'''
-:::* 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
+* 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
-:::* Prophylaxis for exposure to Brucella species routinely consists of a combination of doxycycline and rifampin. RB51, however, is resistant to rifampin in vitro, so rifampin is not recommended.
+* Preferred regimen (2): [[Gentamicin]] 5 mg/kg/day IM/ IV q24h for 7-10 days
-:::* Both those with high and low risk exposures should be monitored for the development of symptoms of brucellosis. Routine serologic tests for brucellosis will not be effective in monitoring for infection. Monitoring, from the last exposure, should include:
+* Alternative regimen (1): [[TMP/SMZ]]AND [[Rifampicin]] 15 mg/kg/day PO for 6 weeks
-:::** For 4 weeks: temperature should be actively monitored
+* Alternative regimen (2): [[Rifampicin]]AND an [[Aminoglycoside]]
-:::** For 6 months: broader symptoms of brucellosis should be passively monitored.
+|-
+|.'''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: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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