Brucellosis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Brucellosis}} | {{Brucellosis}} | ||
{{CMG}}; {{AE}} {{RT}} {{DL}} | {{CMG}}; {{AE}} {{RT}} {{DL}} {{VD}} | ||
==Overview== | ==Overview== | ||
The mainstay of [[therapy]] for brucellosis is antimicrobial therapy. The preferred regimen for uncomplicated brucellosis is a combination of [[Doxycycline]] and [[ | 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== | ==Medical Therapy== | ||
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 | </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. | * 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 | * The use of more than one [[antibiotic]] is needed for several weeks, due to the fact that the [[bacteria]] incubates within [[cells]]. | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="2" |Antimicrobial therapy for Brucellosis | ! colspan="2" |Antimicrobial therapy for Brucellosis | ||
| Line 26: | Line 26: | ||
:* Preferred regimen: [[Doxycycline]] for 3 months AND [[Streptomycin]] for 2 to 3 weeks. | :* Preferred regimen: [[Doxycycline]] for 3 months AND [[Streptomycin]] for 2 to 3 weeks. | ||
* '''Neurobrucellosis''' | * '''Neurobrucellosis''' | ||
:* Preferred regimen: [[Ceftriaxone]] 2 mg IV q12h for 1 | :* 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''' | * '''Brucella endocarditis''' | ||
:* Preferred regimen: [[Doxycycline]] | :* 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 | ||
:* Note: [[Rifampicin]] | :* Note: [[Rifampicin]] or [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate [[cell]] membranes | ||
|- | |- | ||
|'''Pregnancy''' | |'''Pregnancy''' | ||
| | | | ||
* Preferred regimen: [[Rifampin|Rifampicin]] 900 mg PO qd for 6 weeks | * Preferred regimen: [[Rifampin|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]]. | * 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''' | |.'''For children < 8 yrs of age''' | ||
| | | | ||
* Preferred regimen (1): [[TMP/SMZ]] 8/40 mg/ kg/day PO bid for 6 | * 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 (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 (1): [[TMP/SMZ]]AND [[Rifampicin]] 15 mg/kg/day PO for 6 weeks | ||
| Line 48: | Line 48: | ||
* Preferred regimen (2): [[TMP/SMZ]] 160 mg/800mg PO bid for at least 3 weeks | * Preferred regimen (2): [[TMP/SMZ]] 160 mg/800mg PO bid for at least 3 weeks | ||
|} | |} | ||
==Reference== | ==Reference== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Pulmonology]] | |||
[[Category:Hepatology]] | |||
[[Category:Rheumatology]] | |||
[[Category:Nephrology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 20:44, 29 July 2020
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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] 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 |
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| Complications of brucellosis |
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| Pregnancy |
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| .For children < 8 yrs of age |
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| .Post-exposure prophylaxis |
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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.