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

  • 1.Uncomplicated brucellosis in adults and children ≥8yrs of age
  • 2. Complications of brucellosis
  • 2.1 Spondylitis
  • 2.2 Neurobrucellosis
  • 2.3 Brucella endocarditis
  • 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
  • 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

  1. Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016
  2. Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
  3. Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  4. Brucellosis. CDC. http://www.cdc.gov/brucellosis/veterinarians/rb51-reduce-risk.html. Accessed on February 5, 2016

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