Brucellosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of [[therapy]] for brucellosis is | 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="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref><ref name="h">Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016</ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
* Treatment can be effective with | * Treatment can be effective with antibiotics. | ||
* [[Doxycycline]] and [[Streptomycin]] are used in combination for 2-3 weeks to [[Prevention (medical)|prevent]] recurring [[infection]]. | * [[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, | * 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 | * 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><ref name="a">Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016</ref> | ||
===Antimicrobial Regimen=== | ===Antimicrobial Regimen=== | ||
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::::* Note: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes | ::::* Note: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes | ||
::* 3. '''Pregnancy''' | ::* 3. '''Pregnancy''' | ||
:::* Preferred regimen: [[Rifampin]] 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]]. | ||
::* 4.'''For children < 8 yrs of age''' | ::* 4.'''For children < 8 yrs of age''' | ||
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:::* Preferred regimen (1): [[Doxycycline]] 100mg PO bid for at least 3 weeks | :::* 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 (2): [[TMP/SMZ]] 160 mg/800mg PO bid for at least 3 weeks | ||
==Reference== | ==Reference== | ||
Revision as of 14:38, 9 February 2016
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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
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][2]
Medical Therapy
- Treatment can be effective with antibiotics.
- 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.[3][1]
Antimicrobial Regimen
-
- 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: 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.
- 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
- 5.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
- ↑ 1.0 1.1 Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016
- ↑ Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016
- ↑ Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016
- ↑ 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.
- ↑ Brucellosis. CDC. http://www.cdc.gov/brucellosis/veterinarians/rb51-reduce-risk.html. Accessed on February 5, 2016