Treatment of brucella spondylitis: lessons from an impossible meta-analysis and initial report of efficacy of a fluoroquinolone-containing regimen

Pappas, Georgios; Seitaridis, Savvas; Akritidis, Nikolaos; Tsianos, E.V.

doi:10.1016/j.ijantimicag.2004.05.003

Cited by 60 publications

(51 citation statements)

References 42 publications

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“…Quinolones were used in various retrospective, as well as prospective (non-RCT), studies (Table 3) (7,9,12,22,33,43,(59)(60)(61). It should be mentioned that such studies are generally more difficult to identify in searches of literature databases, because treatment is not the focus in a considerable proportion of them.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…In addition, there are case reports, or reports of single cases within larger studies, that offer some data regarding the use of quinolones as alternatives to standard treatment when the latter causes toxicity to the patients (14,16,19). Also, successful treatment of relapse of brucellosis by the use of quinolone-based regimens, in cases where standard treatments failed, has been described (28,43). Finally, there are promising reports regarding the use of a quinolone as the third agent in therapeutic combinations for complicated and difficult-to-treat cases of brucellosis (2,40,63,64,66).…”

Section: Clinical Studiesmentioning

confidence: 99%

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Quinolones for Treatment of Human Brucellosis: Critical Review of the Evidence from Microbiological and Clinical Studies

Falagas

Bliziotis

2006

Antimicrob Agents Chemother

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3Brucellosis is a zoonotic disease with worldwide distribution that is endemic in the Mediterranean region, the Middle East, Central Asia, and parts of Africa and Latin America. Worldwide, brucellosis remains a major cause of morbidity in humans and domesticated animals. In animals, bovine brucellosis, caused mainly by Brucella abortus, is still the most widespread form. In humans, ovine/caprine brucellosis caused by Brucella melitensis is by far the most common type of disease. The disease has a wide spectrum of clinical manifestations and can affect a variety of organs and systems. Localized and complicated forms of brucellosis cause important morbidity and require prolonged medical treatment. Fortunately, mortality is relatively low and is related mainly to cardiovascular and central nervous system complications of the disease.Although several studies have been conducted over the past 2 decades, there is no conclusive evidence on the optimum antibiotic therapy for brucellosis. Disease relapse still represents one of the most important therapeutic problems. The last recommendation by the World Health Organization (WHO) for the treatment of acute brucellosis in adults was published in 1986 and suggested 600 to 900 mg rifampin and 200 mg doxycycline daily for a minimum of 6 weeks (8). Alternatively, the WHO suggested that rifampin could be replaced with 15 mg/kg of streptomycin, administered intramuscularly for only 2 weeks. However, a meta-analysis, as well as a prospective randomized trial, both performed by Solera et al., showed that the "good old" combination regimen of streptomycin with an oral tetracycline results in fewer relapses than the doxycycline-rifampin combination (57, 58). Controlled clinical trials with other antibiotics, including trimethoprim-sulfomethoxazole, new macrolides, and ␤-lactams, have shown inferior results or involved too few patients for a proper evaluation. Thus, the most widely used regimens are the two aforementioned combinations that were recommended by the WHO. In addition, rifampin monotherapy is the main option for brucellosis during pregnancy, whereas its combination with trimethoprim-sulfomethoxazole is the suggested treatment for childhood brucellosis (5, 34).Certain focal forms of brucellosis are difficult to treat, and surgery should be considered for patients with endocarditis or cerebral, epidural, splenic, or other abscesses (20, 41). Regarding medical treatment, although the antibiotics used are essentially the same, prolonged therapy, up to six or more months, may be needed for patients with osteoarticular forms of the disease, and especially spondylitis (18,56,65). Also, tripleantibiotic combinations were found to be of value in some case series of brucellar endocarditis, spondylitis, and meningitis (2, 41, 65). Relapse of the disease also represents a major therapeutic problem for its focal forms.Since the mid 1980s, laboratory researchers and clinicians have performed several microbiological and clinical studies of the possible use of quinolones in the treatmen...

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Section: Clinical Studiesmentioning

confidence: 99%

Section: Clinical Studiesmentioning

confidence: 99%

Quinolones for Treatment of Human Brucellosis: Critical Review of the Evidence from Microbiological and Clinical Studies

Falagas

Bliziotis

2006

Antimicrob Agents Chemother

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“…Spondylitis may be complicated by potentially devastating neurological defects and residual disability may result from even protracted treatment [7][8][9]. Treatment of brucellar spondylitis remains controversial regarding the selection of antibiotics, the duration of treatment, and the role of surgery.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of treatment in 50 cases with spinal brucellosis in Babol, Northern Iran

Gangi

Roushan

Janmohammadi

et al. 2012

J Infect Dev Ctries

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Introduction: Duration of treatment for brucellar spondylitis in endemic regions is controversial. This study describes the outcome of treatment in 50 cases of brucellar spondylitis in Iran. Methodology: From April 2001 to September 2010, we treated 20, 13, 11 and 6 cases with doxycycline plus rifampin (DR), streptomycin plus doxycycline plus rifampin (SDR), cotrimoxazole plus doxycycline plus rifampin (CDR), and gentamicin plus doxycycline plus rifampin (GDR), respectively. Gentamicin and streptomycin were administered for 14 days and the other agents for 3 months. When complete clinical response was not achieved, therapy was continued. All patients were followed for one year. The Kaplan Meier method and the log rank test were used to compare the duration of therapy between SDR plus GDR patients with those treated with CDR or DR. Results: Eight (45%), 10 (76.9%), 7 (63.3%) and 6 (100%) cases treated for three months were cured with DR, SDR, CDR and GDR, respectively. Nine (45%), 4 (36.4%) and two (22.2%) were cured after four months with DR, CDR and SDR, respectively. Mean duration of therapy in the SDR plus GDR, CDR and DR was 3.26±0.17, 3.36±0.15 and 3.9±0.23 months, respectively (p=0.49 and p=0.015, respectively). Three cases with epidural or paravertebral abscesses recovered after six months. Relapse occurred in one (9.1%) and two (10%) cases treated with CDR and DR, respectively. Conclusions: Brucellar spondylitis could be treated using different combinations of antimicrobials especially with a regimen containing aminoglycoside for four months; patients with epidural or paravertebral abscesses require longer treatment times.

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“…24 Segundo uma meta-análise, que avaliou oito estudos relevantes, os resultados estão relacionados com a duração do tratamento e não com o tipo de regime terapêutico usado. 25 Os doentes com focalização osteo-articular beneficiam de um tratamento prolongado. Um estudo prospectivo de EB, no qual foi avaliada a eficá-cia de uma terapêutica superior a seis meses, apresentou taxas de sucesso de 100,0%, sem recidivas, sequelas graves ou mortalidade.…”

Section: Discussionunclassified

Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos

Lebre

Vélez²,

Seixas³

et al. 2014

Acta Med Port

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Introduction:Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy. Material and Methods:Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period . Results: We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring. Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial. Conclusions: Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its' duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.

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Treatment of brucella spondylitis: lessons from an impossible meta-analysis and initial report of efficacy of a fluoroquinolone-containing regimen

Cited by 60 publications

References 42 publications

Quinolones for Treatment of Human Brucellosis: Critical Review of the Evidence from Microbiological and Clinical Studies

Quinolones for Treatment of Human Brucellosis: Critical Review of the Evidence from Microbiological and Clinical Studies

Outcomes of treatment in 50 cases with spinal brucellosis in Babol, Northern Iran

Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos

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