Brucellosis medical therapy: Difference between revisions

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Revision as of 19:49, 4 January 2017

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 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 ANDDoxycycline 100 mg PO bid for 4-5 month AND Rifampicin 600–900 mg/day PO for 4-5 month Brucella endocarditis Preferred regimen: DoxycyclineAND an Aminoglycoside for at least 8 weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary Note: Rifampicin ORTrimethoprim/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 ANDStreptomycin 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

↑ ^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

Template:WH Template:WS

[a-1] 1.0 ^1.1 Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016

[h-2] Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016

[b-3] Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016

[1]

[2]

[3]

@@ Line 12: / Line 12: @@
 * 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>
+{| class="wikitable"
-===Antimicrobial Regimen===
+! colspan="2" |Antimicrobial therapy for Brucellosis
-:* '''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="i">Brucellosis. CDC. http://www.cdc.gov/brucellosis/veterinarians/rb51-reduce-risk.html. Accessed on February 5, 2016</ref>
+|-
-::* 1.'''Uncomplicated brucellosis in adults and children ≥8yrs of age'''
+|'''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
+* Preferred regimen: [[Doxycycline]] 100 mg  PO bid for 6 weeks {{and}} [[Streptomycin]] 1 g/day IM  for  2-3 weeks
-:::* 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 (1): [[Doxycycline]] 100 mg/day PO for six weeks {{and}} [[Gentamicin]] 5mg/kg IM  for 7-days
-::* 2. '''Complications of brucellosis'''
+* Alternative regimen (2): [[Gentamicin]] 5mg/kg/day IV/ IM  for 7-10 days  {{and}} [[Rifampicin]] 600–900 mg/day PO for six weeks
-:::* 2.1 '''Spondylitis'''
+|-
-::::* Preferred regimen:[[ Doxycycline]] for 3 months  {{and}} [[Streptomycin]] for 2 to 3 weeks.
+|'''Complications of brucellosis'''
-:::* 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
+* '''Spondylitis'''
-:::* 2.3 '''Brucella endocarditis'''
+:* Preferred regimen: [[Doxycycline]] for 3 months AND [[Streptomycin]] for 2 to 3 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
+* '''Neurobrucellosis'''
-::::* Note: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes
+:* 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
-::* 3. '''Pregnancy'''
+* '''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
-::* 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
+|'''Pregnancy'''
-:::* 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
+* Preferred regimen: [[Rifampin|Rifampicin]] 900 mg PO qd for 6 weeks
-:::* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
+* 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]].
-::* 5.'''Post-exposure prophylaxis'''
+|-
-:::* Preferred regimen (1): [[Doxycycline]] 100mg PO bid for at least 3 weeks
+|.'''For children < 8 yrs of age'''
-:::* 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
+* 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]]
+|-
+|.'''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 medical therapy: Difference between revisions

Revision as of 19:49, 4 January 2017

Overview

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