Efficacy and Tolerability of Antibiotic Combinations in Neurobrucellosis: Results of the Istanbul Study

Abstract

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ؎ 2.47 months in P1, 6.52 ؎ 4.15 months in P2, and 5.18 ؎ 2.27 months in P3) (P ‫؍‬ 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n ‫؍‬ 5/166, 3.0%) and the oral therapy (n ‫؍‬ 4/42, 9.5%) (P ‫؍‬ 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n ‫؍‬ 6/166 [3.6%] versus n ‫؍‬ 6/42 [14.3%]; P ‫؍‬ 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n ‫؍‬ 6/42) compared to P1 (2.6%, n ‫؍‬ 3/117) and P3 (6.1%, n ‫؍‬ 3/49) (P ‫؍‬ 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Management of Brucella endocarditis: results of the Gulhane study

“…As an example, ceftriaxone-based regimens were found to be more successful and to require shorter therapy than the oral treatment protocol in the management of neurobrucellosis [15]. The probable reason may be the superior accumulation of ceftriaxone in the cerebrospinal fluid.…”

Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

“…The treatment period was significantly shorter (median = 5 months) than an oral treatment protocol (median = 6 months) (12). However, the surgical procedure for SDE is controversial.…”

Progressive weakness and intermittent low-grade fever in a Libyan man

“…The general consensus is that antibiotic regimens should include doxycycline (bactericidal) and rifampicin (bacteriostatic) and a 2012 study suggested that regimens containing ceftriaxone lead to shorter courses of antibiotic therapy 6 . Brucella species are intracellular organisms and this therefore confers protection, at least in part, against many antibiotics.…”