Update on brucellosis: therapeutic challenges.

Brucellosis is an extremely important disease around the world, especially in developing countries. Its clinical manifestations and severity vary with the patient population studied and the species of Brucella involved. The choice of regimen and duration of antimicrobial therapy should be based on whether focal disease is present or there are underlying conditions that contraindicate certain antibiotics (e.g. pregnant patients or children under 8 years old). Most individuals with acute brucellosis respond well to a combination of doxycycline plus aminoglycosides or rifampicin for 6 weeks. Monotherapy with doxycycline or minocycline, or a combination of doxycycline plus trimethoprim-sulfamethoxazole, or a quinolone plus rifampicin may be an alternative. Patients with focal disease, such as spondylitis or endocarditis, may require longer courses of antibiotics, depending on clinical evolution. Tetracycline monotherapy, especially with doxycycline, is a good option for patients with brucellosis with no focal lesions and a low risk of relapse. In this clinical situation, practitioners should avoid the use of high-cost or more toxic schedules.