Seyed Mohammad Alavi1, Leila Alavi. 1. Jundishapur Infectious and Tropical Diseases Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran.
Abstract
BACKGROUND: The treatment of human brucellosis is controversial. The purpose of this study was to search published clinical trial papers to provide a simple and effective treatment in brucellosis. METHODS: Many studies on brucellosis treatment in a twenty- year span from 1993 to 2012 were searched in PubMed, Web of Science (ISI), Scopus, Google Scholar, Magiran, Iranmedex and SID. The studies that were searched and classified in groups according to combination therapy and monotherapy and their results in treatment outcome were compared. Regimens with lower treatment failure or relapse were considered as more suitable for brucellosis treatment. RESULTS: The comparison of combined doxycycline and rifampicin (DR) with a doxycycline plus streptomycin (DS) favors the latter regimen. The combined doxycycline/cotrimoxazole (DCTM) showed similar effect with DR. The treatment with the combined regimen including quinolones was similar to DR but with higher relapse rates. Higher relapse rate was searched in monotherapy (13% vs. 4.8%) and in short-term (less than 4 weeks) treatment regimen (22% vs. 4.8%), respectively. Although in children, clinical trials were limited but showed cotrimoxazole plus rifampin for six weeks was the best treatment regimen. CONCLUSION: In uncomplicated brucellosis in adult patients, doxycycline-aminoglycoside combination is the first choice with doxycycline- rifampin and doxycycline-cotrimoxazole should be the alternative regimens. The other oral regimens including quinolones may be considered as alternatives. Cotrimoxazole plus rifampin for six weeks may be the regimen of choice for the treatment of patients younger than 8 years old. Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen.
BACKGROUND: The treatment of humanbrucellosis is controversial. The purpose of this study was to search published clinical trial papers to provide a simple and effective treatment in brucellosis. METHODS: Many studies on brucellosis treatment in a twenty- year span from 1993 to 2012 were searched in PubMed, Web of Science (ISI), Scopus, Google Scholar, Magiran, Iranmedex and SID. The studies that were searched and classified in groups according to combination therapy and monotherapy and their results in treatment outcome were compared. Regimens with lower treatment failure or relapse were considered as more suitable for brucellosis treatment. RESULTS: The comparison of combined doxycycline and rifampicin (DR) with a doxycycline plus streptomycin (DS) favors the latter regimen. The combined doxycycline/cotrimoxazole (DCTM) showed similar effect with DR. The treatment with the combined regimen including quinolones was similar to DR but with higher relapse rates. Higher relapse rate was searched in monotherapy (13% vs. 4.8%) and in short-term (less than 4 weeks) treatment regimen (22% vs. 4.8%), respectively. Although in children, clinical trials were limited but showed cotrimoxazole plus rifampin for six weeks was the best treatment regimen. CONCLUSION: In uncomplicated brucellosis in adult patients, doxycycline-aminoglycoside combination is the first choice with doxycycline- rifampin and doxycycline-cotrimoxazole should be the alternative regimens. The other oral regimens including quinolones may be considered as alternatives. Cotrimoxazole plus rifampin for six weeks may be the regimen of choice for the treatment of patients younger than 8 years old. Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen.
Authors: M R Hasanjani Roushan; M J Soleimani Amiri; N Janmohammadi; M Sadeghi Hadad; M Javanian; M Baiani; A Bijani Journal: J Antimicrob Chemother Date: 2010-03-09 Impact factor: 5.790
Authors: G Acocella; A Bertrand; J Beytout; J B Durrande; J A Garcia Rodriguez; J Kosmidis; M Micoud; M Rey; M Rodriguez Zapata; J Roux Journal: J Antimicrob Chemother Date: 1989-03 Impact factor: 5.790
Authors: Javier Ariza; Mile Bosilkovski; Antonio Cascio; Juan D Colmenero; Michael J Corbel; Matthew E Falagas; Ziad A Memish; Mohammad Reza Hasanjani Roushan; Ethan Rubinstein; Nikolaos V Sipsas; Javier Solera; Edward J Young; Georgios Pappas Journal: PLoS Med Date: 2007-12 Impact factor: 11.069