From the Guidelines
Brucellosis should be treated with a six-week regimen of doxycycline combined with either streptomycin for 2–3 weeks or rifampicin for six weeks, as this is the optimal treatment for uncomplicated cases, according to the Ioannina recommendations 1. The treatment of brucellosis is complex and requires the administration of more than one antibiotic for a prolonged period.
- The optimal treatment regimen is based on a combination of doxycycline and either streptomycin or rifampicin, with gentamicin considered an acceptable alternative to streptomycin 1.
- The use of doxycycline combined with streptomycin for 2–3 weeks or rifampicin for six weeks is recommended for uncomplicated cases of brucellosis, as stated in the Ioannina recommendations 1.
- Other regimens or combinations should be considered second-line treatments, emphasizing the importance of following the recommended guidelines for optimal patient outcomes. The development of a common global therapeutic language for human brucellosis and future clinical trials would help resolve controversies surrounding the disease, ultimately leading to improved treatment strategies and patient care 1.
- Brucellosis remains a significant public health concern, being the most common anthropozoonosis worldwide, and its treatment requires careful consideration of the most effective antibiotic regimens.
- The Ioannina recommendations provide a consensus statement on the treatment of brucellosis, aiming to establish a unified approach to managing this complex infection 1.
From the Research
Treatment Options for Brucellosis
- The most effective treatment for brucellosis is a combination of antibiotics, with doxycycline and streptomycin being a commonly recommended regimen 2, 3.
- Doxycycline plus rifampicin is another commonly used regimen, but it has been shown to be less effective than doxycycline plus streptomycin in some studies 2, 3.
- The addition of gentamicin to the doxycycline-rifampin regimen has been shown to decrease the rate of relapses 4.
- Triple therapy with doxycycline-rifampin-amikacin has also been evaluated and shown to have a higher efficacy and more rapid action in terms of relief of symptoms compared to the doxycycline-rifampin regimen 5.
Comparison of Treatment Regimens
- A systematic review of 25 studies comparing various antibiotic regimens for the treatment of human brucellosis found that doxycycline plus streptomycin was more effective than doxycycline plus rifampicin 2.
- Another study found that the doxycycline-rifampin-gentamicin regimen had a significantly lower relapse rate compared to the doxycycline-rifampin combination 4.
- A comparison of doxycycline-rifampin-amikacin and doxycycline-rifampin regimens found that the triple therapy regimen had a higher efficacy and more rapid action in terms of relief of symptoms 5.
Treatment Outcomes
- The outcomes of interest in the treatment of brucellosis include relapse, persistence of symptoms at the end of treatment, and adverse drug effects 2.
- The doxycycline plus streptomycin regimen has been shown to have a lower relapse rate and fewer adverse drug effects compared to the doxycycline plus rifampicin regimen 2, 3.
- The addition of gentamicin to the doxycycline-rifampin regimen has been shown to decrease the rate of relapses, but may also increase the risk of adverse drug effects 4.