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 being considered an acceptable alternative to streptomycin 1.
- The use of doxycycline and streptomycin or rifampicin for six weeks is recommended as the first-line treatment, while all other regimens or combinations should be considered second-line 1.
- The development of a common global therapeutic language for human brucellosis and future clinical trials would help to solve controversies regarding the disease and provide more effective treatment options 1. The treatment of brucellosis requires careful consideration of the potential complications and the need for prolonged antibiotic treatment to completely eradicate the infection.
- The standard regimen of doxycycline and streptomycin or rifampicin is effective in treating uncomplicated cases, but more severe cases may require extended treatment duration or alternative regimens 1.
From the Research
Treatment of Brucellosis
- The treatment of human brucellosis is controversial, with various antibiotics and combinations being used 2.
- A study comparing doxycycline-rifampin versus doxycycline-rifampin-gentamicin found that the addition of gentamicin decreased the rate of relapses 3.
- Another study found that doxycycline plus streptomycin was more effective than doxycycline plus rifampicin in treating human brucellosis 2.
- A systematic review of studies on brucellosis treatment found that regimens with lower treatment failure or relapse were considered more suitable for brucellosis treatment 4.
Antibiotic Regimens
- Doxycycline-rifampin is a commonly used regimen for treating brucellosis, but it has been found to have a higher relapse rate compared to other regimens 3, 2.
- The addition of gentamicin to doxycycline-rifampin has been found to decrease the rate of relapses 3.
- Doxycycline plus streptomycin has been found to be more effective than doxycycline plus rifampicin in treating human brucellosis 2, 5.
- Quinolone plus rifampicin has been found to be slightly better tolerated than doxycycline plus rifampicin, but with no significant difference in overall effectiveness 2.
Treatment Outcomes
- A study found that the combination of oral doxycycline for 45 days plus intramuscular gentamicin for 7 days was equally as effective as traditional therapy using doxycycline for 45 days plus streptomycin for 14 days 5.
- Another study found that the addition of amikacin to doxycycline-rifampin had a higher efficacy and more rapid action in terms of relief of symptoms, but with no significant difference in drug side-effects and disease relapse 6.
- A systematic review found that higher relapse rates were associated with monotherapy and short-term treatment regimens 4.