Comparison of Five Antimicrobial Regimens for the Treatment of Brucellar Spondylitis: A Prospective, Randomized Study

Bayındır, Yaşar; Sönmez, Emine; Aladag, A.; Büyükberber, Nuray

doi:10.1179/joc.2003.15.5.466

Cited by 53 publications

(34 citation statements)

References 24 publications

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“…Triple therapy was administered in two other studies [15]–[25], however, they involved only patients presenting osteoarticular brucellosis. Bayindir et al [15] carried out a study in patients with brucella spondylitis.…”

Section: Resultsmentioning

confidence: 99%

“…Bayindir et al [15] carried out a study in patients with brucella spondylitis. Twenty two patients receiving combined rifampicin and doxycycline for 45 days, together with streptomycin over the first 15 days were included in the study and the results were extremely good regarding relapse and treatment failure, with a 100% response rate and no relapses.…”

Section: Resultsmentioning

confidence: 99%

“…Bayindir et al [15] administered ofloxacin and rifampicin for 45 days to 19 patients with spondylitis, with poor results, comprising a treatment failure rate of 26% and a 26% relapse rate. Alp et al.…”

Section: Resultsmentioning

confidence: 99%

“…The conclusions were based on the disappearance of fever after two weeks of treatment, a time extremely long for evaluating the clinical response which, as already stated, occurred in all studies within the first few days of the start of treatment [56], [66]. Other studies of triple therapy were performed in patients presenting osteoarticular brucellosis [15], [35], and therefore the conclusions of these studies cannot be extrapolated to patients with uncomplicated brucellosis. As a result, this triple therapy cannot be recommended as the treatment of choice for human brucellosis until data supporting its usefulness is obtained in randomized clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…This recommendation is based on two studies. One study, involved the comparison of 5 different therapeutic regimens in 102 patients with lumbar spondylitis [15] and concluded recommending streptomycin for 15 days and doxycycline and rifampicin for 45 days in these cases. However, in patients with focal complications of brucellosis such as brucella spondylitis, longer or more aggressive curative therapy may be necessary than in patients with uncomplicated brucellosis.…”

Section: Introductionmentioning

confidence: 99%

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Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

Pozo¹,

2012

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BackgroundBrucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance.Methods and FindingsA search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified.Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05–4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81–4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63–2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future.ConclusionsAlthough the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

Pozo¹,

2012

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Antibiotics for treating human brucellosis

Yousefi‐Nooraie

Mortazhejri

Mehrani

et al. 2012

Cochrane Database of Systematic Reviews

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Doxycycline (six weeks) plus streptomycin (two or three weeks) regimen is more effective regimen than doxycycline plus rifampicin (six weeks) regimen. Since it needs daily intramuscular (IM) injection, access to care and cost are important factors in deciding between two choices. Quinolone plus rifampicin (six weeks) regimen is slightly better tolerated than doxycycline plus rifampicin, and low quality evidence did not show any difference in overall effectiveness.

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Spinal brucellosis: Turkish experience based on 452 cases published during the last century

Turğut

Turgut

Koşar

2006

Acta Neurochir (Wien)

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Comparison of Five Antimicrobial Regimens for the Treatment of Brucellar Spondylitis: A Prospective, Randomized Study

Cited by 53 publications

References 24 publications

Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

Antibiotics for treating human brucellosis

Spinal brucellosis: Turkish experience based on 452 cases published during the last century

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