Treatment Of Brucellosis

Question 1

Treatment

Answer 1

1- There are 3 questions guide the management
- Is the disease acute (duration < 1month) or relapsing or chronic ( > 6
months)
- Is there focal disease of bone or joints or other complications?
- Has TB definitely been excluded?

Question 2

Treatment

Answer 2

Principles of treatment
- Monotherapy should not be used because, although clinical illness responds in short time, early relapse occurs in > 30% of cases
- Combination of 2 antibiotics is the preferred regimen
- Triple therapy is indicated in complicated cases
- In patients in whom TB has not been excluded
 Use antimicrobials to which only brucellosis responds (i.e. don’t use streptomycin or rifampicin) or

Question 3

Treatment

Answer 3

A-First-line Regimen (Adults and children >8 years): RD

Doxycycline 100 mg orally twice daily for 6 weeks
+
Rifampicin 600–900 mg orally once daily for 6 weeks
This is the most commonly recommended regimen by WHO.

B-Alternative regimens:

*Doxycycline for 6 weeks + Streptomycin (1 g IM daily for the first 2–3 weeks): May be more effective than doxy + rifampin but less convenient due to injections.

*Doxycycline + Gentamicin (5 mg/kg/day IV/IM for 7–10 days)

*Trimethoprim-Sulfamethoxazole + Rifampicin: In children <8 years or pregnant women (with caution.
*Rifampicin alone can be used in pregnancy.
*Sulfa-TMP is not preferred in 1st trimester

Question 4

Treatment

Answer 4

Complicated cases
*Endocarditis:
6 months of triple therapy, the 1st month Gentamicin + Rifampicin + Doxycycline
Then 5 months of Rifampicin + Doxycycline + Co-Trimoxazole.
*Patients with endocarditis often need valve replacement
E: Neurobrucellosis:
1 year of triple therapy. Rifampicin must be used all the time.
NB: Third generation Cephalosporine can substitute Aminoglycosides for better penetration of blood brain barrier
-In neurrobrucellosis add 2c
(Ceftriaxone+cortisone)
- F: Bones & Joints:
1 Year of triple therapy NB: Doxycycline must be all the time.
G- Relapse:
Triple therapy for 3 months
*Quinolone Therapy in Brucellosis:
Ciprofloxacin in a dose of 750 mgm 3 times daily for 1 month can be used in cases of terminal liver cell failure.

Question 5

Treatment

Answer 5

Acute cases → 2 drugs for 6 weeks
- Chronic or relapsing cases → 2 drugs for 3 months
- Complicated cases → 3 drugs for 3 months