Brucellosis medical therapy
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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. 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.
Medical Therapy
Treatment can be effective with antibiotics. Usually, 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.[1]
Antimicrobial Regimen
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- 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: 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.
- 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
- 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.
- 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:
- For 4 weeks: temperature should be actively monitored
- For 6 months: broader symptoms of brucellosis should be passively monitored.
Reference
- ↑ 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