Recognition and Optimum Treatment of Brucellosis

Abstract

Brucellosis (infection with Brucella spp.) is a common zoonosis in many parts of the world. Human brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. Treatment of brucellosis must effectively control acute illness and prevent complications and relapse. The choice of regimen and duration of antimicrobial therapy should be based on the presence of focal disease and underlying conditions which contraindicate certain specific antibiotics. The regimen of first choice is combination therapy with doxycycline for 45 days and streptomycin for 14 days. Gentamicin or netilmicin for the first 7 days may be substituted for streptomycin. Second-choice regimens consist of combinations of doxycycline and rifampicin (rifampin) for 45 days, or monotherapy with doxycycline for 45 days. Surgery should be considered for patients with endocarditis, cerebral or epidural abscess, spleen abscess or other abscesses which are antibiotic-resistant. Tetracyclines are generally contraindicated for pregnant patients and children < 8 years old. Rifampicin 900 mg once daily for 6 weeks is considered the drug of choice for treating brucellosis in pregnant women. In children < 8 years old the preferred regimen is rifampicin with cotrimoxazole (trimethoprim-sulfamethoxazole) for 45 days. An alternative regimen consists of a combination of rifampicin for 45 days with gentamicin 5 to 6 mg/kg/day for the first 5 days.

Multicenter Study of Brucellosis in Egypt

“…Prevalence of a serologic reaction was 4.98% for cattle, 3 Isolation of the causative agent is still the standard diagnostic method for brucellosis (9). Thus, for defi nitive and confi rmative diagnosis of serologically reactive animals, bacteriologic isolation and identifi cation of Brucella spp.…”

“…It is caused by gram-negative coccobacilli of the genus Brucella and affects cattle, sheep, goats, and other livestock (2,3). Since the discovery of Brucella melitensis by David Bruce in 1887, several species have been identifi ed, such as B. abortus (which infects cattle), B. melitensis (which infects sheep and goats), B. suis, B. neotomae, B, ovis, and B. canis (2,4).…”

Human brucellosis in a non-susceptible host: a case report

“…13 For children less than 8 years of age, a combination of TMP-SMX and aminoglycoside or a combination of rifampicin and TMP-SMX for 45 days is needed. 14,15 …”

Chemical and Biological Factors in the Control of Brucella and Brucellosis

“…doxycycline 100 mg twice/day for 45 days and streptomycin 1 g/day for 14 days or gentamicin 5-6 mg/Kg/d for 7 days) has proven to be the best treatment for the disease [10,13]. However, with relapses of 3-5% [10], plus serious side effects due to the tetracyclines, especially in children and pregnant women [4][5][6][7][8][9][10][11][12][13][14], there is the need to press on in search of new alternatives. Aminoglycosides are extremely active antimicrobial agents, particularly against bacteraemia caused by aerobic gram-negative bacilli [15].…”