From the Guidelines
The recommended treatment for Mediterranean fever (Brucellosis) is a combination antibiotic therapy consisting of doxycycline 100 mg twice daily for 6 weeks plus streptomycin 15 mg/kg daily intramuscularly for 2-3 weeks, or alternatively, doxycycline plus rifampin 600-900 mg daily for 6 weeks, as recommended by the Ioannina recommendations 1.
Key Considerations
- The choice of treatment regimen should be based on the severity of the disease, patient factors, and local resistance patterns.
- Combination therapy is essential to prevent relapse and reduce the risk of complications.
- The use of gentamicin as an alternative to streptomycin may be considered, but the duration of treatment should be further evaluated in future randomized control trials 1.
Treatment Options
- DOX-STR: doxycycline 100 mg twice daily orally for 6 weeks; streptomycin 15 mg/kg daily intramuscularly for 2–3 weeks, recommended as a first-line treatment 1.
- DOX-RIF: doxycycline 100 mg twice daily orally for 6 weeks; rifampicin 600–900 mg daily for 6 weeks, recommended as an alternative first-line treatment 1.
- DOX-GENT: doxycycline 100 mg twice daily orally for 6 weeks; gentamicin 5 mg/kg daily parenterally in 1 dose for 7 days, recommended as a second-line treatment 1.
Special Considerations
- Children under 8 years: trimethoprim-sulfamethoxazole combined with rifampin may be preferred to avoid tetracycline-related dental staining.
- Pregnant women: rifampin alone may be used as a treatment option.
- Patients should be monitored for side effects, including gastrointestinal disturbances, photosensitivity from doxycycline, and potential hearing loss from streptomycin.
From the FDA Drug Label
For concomitant use with other agents to which the infecting organism is also sensitive: Streptomycin is considered a second-line agent for the treatment of ... brucellosis; For adults: 1 to 2 grams in divided doses every six to twelve hours for moderate to severe infections. Doses should generally not exceed 2 grams per day. For children: 20 to 40 mg/kg/day (8 to 20 mg/lb/day) in divided doses every 6 to 12 hours.
The recommended treatment for Mediterranean fever (Brucellosis) with streptomycin is 1 to 2 grams in divided doses every six to twelve hours for moderate to severe infections, with a maximum daily dose of 2 grams for adults, and 20 to 40 mg/kg/day in divided doses every 6 to 12 hours for children 2.
From the Research
Treatment Options for Mediterranean Fever (Brucellosis)
The recommended treatment for Mediterranean fever, also known as Brucellosis, typically involves combination drug therapy. The following are some of the treatment options:
- Doxycycline-Rifampin Combination: This combination is commonly used to treat Brucellosis 3, 4, 5. The treatment typically lasts for 6-8 weeks.
- Doxycycline-Streptomycin Combination: This combination has also been shown to be effective in treating Brucellosis, especially in cases where the disease is caused by Brucella melitensis 4, 6.
- Ofloxacin-Rifampin Combination: This combination has been studied as an alternative to the doxycycline-rifampin combination, with similar efficacy and a shorter treatment duration 5.
- Rifampin Monotherapy: Rifampin has been used as a single agent to treat Brucellosis, especially in cases where other treatments are not effective or tolerated 7.
Key Considerations
When treating Brucellosis, the following considerations are important:
- Treatment Duration: The treatment duration for Brucellosis typically ranges from 6-12 weeks, depending on the severity of the disease and the treatment regimen used.
- Relapse Rates: Relapse rates for Brucellosis can be high, ranging from 5-15%, depending on the treatment regimen used 3, 4, 5.
- Side Effects: Side effects from Brucellosis treatment can occur, but are generally mild and temporary 3, 4, 5.
- Resistance: Resistance to antibiotics used to treat Brucellosis can occur, highlighting the need for careful selection of treatment regimens and monitoring of treatment outcomes 3, 4, 5.