What is the treatment for brucellosis?

From the Guidelines

The optimal treatment for brucellosis is a six-week regimen of doxycycline combined with either streptomycin for 2-3 weeks or rifampicin for six weeks, as recommended by the Ioannina consensus meeting 1. This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of combination therapy to effectively eradicate the Brucella bacteria and prevent complications. The use of doxycycline and streptomycin or rifampicin is supported by studies that have demonstrated their efficacy in treating brucellosis, with relapse rates ranging from 5-10% 1.

Some key points to consider when treating brucellosis include:

• The importance of prompt treatment to prevent complications and reduce the risk of relapse
• The need for a dual antibiotic approach to effectively eradicate the Brucella bacteria
• The use of doxycycline and streptomycin or rifampicin as the first-line treatment regimen
• The consideration of alternative regimens, such as trimethoprim-sulfamethoxazole combined with rifampicin, for children under 8 years old or pregnant women
• The importance of monitoring patients for recurring symptoms for at least a year after treatment

It is also important to note that the treatment of brucellosis should be individualized based on the patient's specific needs and circumstances, and that the use of fluoroquinolones or other alternative regimens should be considered only in the context of properly designed prospective clinical trials 1. Overall, the goal of treatment is to effectively eradicate the Brucella bacteria, prevent complications, and improve the patient's quality of life.

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 treatment for brucellosis with streptomycin is 1 to 2 grams in divided doses every six to twelve hours for adults, and 20 to 40 mg/kg/day in divided doses every 6 to 12 hours for children. Streptomycin is considered a second-line agent for the treatment of brucellosis 2.

From the Research

Treatment Options for Brucellosis

The treatment of brucellosis typically involves the use of antibiotics, with the goal of effectively controlling acute illness and preventing 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 3.

Recommended Treatment Regimens

• 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 3.
• Second-choice regimens consist of combinations of doxycycline and rifampicin (rifampin) for 45 days, or monotherapy with doxycycline for 45 days 3.
• In uncomplicated brucellosis in adult patients, doxycycline-aminoglycoside combination is the first choice with doxycycline-rifampin and doxycycline-cotrimoxazole as alternative regimens 4.
• Cotrimoxazole plus rifampin for six weeks may be the regimen of choice for the treatment of patients younger than 8 years old 4.
• Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen 4.

Comparison of Treatment Regimens

• The comparison of combined doxycycline and rifampicin (DR) with a doxycycline plus streptomycin (DS) favors the latter regimen 4.
• The combined doxycycline/cotrimoxazole (DCTM) showed similar effect with DR 4.
• The treatment with the combined regimen including quinolones was similar to DR but with higher relapse rates 4.
• Doxycycline (six weeks) plus streptomycin (two or three weeks) regimen is more effective regimen than doxycycline plus rifampicin (six weeks) regimen 5.
• Quinolone plus rifampicin (six weeks) regimen is slightly better tolerated than doxycycline plus rifampicin, and low quality evidence did not show any difference in overall effectiveness 5.

Special Considerations

• Tetracyclines are generally contraindicated for pregnant patients and children < 8 years old 3.
• Rifampicin 900 mg once daily for 6 weeks is considered the drug of choice for treating brucellosis in pregnant women 3.
• In children < 8 years old the preferred regimen is rifampicin with cotrimoxazole (trimethoprim-sulfamethoxazole) for 45 days 3.