From the Guidelines
The recommended dose of rifampicin (Rifampin) for treating brucellosis is 600-900 mg daily for 6 weeks, typically as part of a combination therapy regimen. This dose is recommended by the Ioannina recommendations, a consensus statement on the treatment of brucellosis published in 2007 1. Rifampicin should not be used as monotherapy due to the high risk of developing resistance. It is usually combined with doxycycline (100 mg twice daily) for a duration of at least 6 weeks. The combination of doxycycline and rifampicin is considered a first-line treatment for uncomplicated brucellosis, with a recommended duration of 6 weeks 1.
Some key points to consider when using rifampicin for treating brucellosis include:
- Rifampicin works by inhibiting bacterial RNA polymerase, preventing bacterial protein synthesis.
- It achieves good penetration into tissues and cells where Brucella organisms often reside intracellularly.
- Patients should be advised to take rifampicin on an empty stomach, at least 1 hour before or 2 hours after meals.
- Rifampicin may cause orange-red discoloration of body fluids, including urine, tears, and sweat.
- Regular monitoring of liver function is recommended during treatment due to potential hepatotoxicity.
The Ioannina recommendations also suggest that gentamicin may be considered an acceptable alternative to streptomycin, while all other regimens/combinations should be considered second-line 1. However, the use of fluoroquinolones, such as ofloxacin or ciprofloxacin, is not recommended as a first-line treatment due to the risk of enhancing the development of overall fluoroquinolone resistance in the community 1.
In terms of treatment duration, the Ioannina recommendations suggest that a six-week regimen of doxycycline combined with either streptomycin or rifampicin is the optimal treatment for uncomplicated brucellosis 1. However, for more severe or complicated cases, such as neurobrucellosis or endocarditis, a third agent like an aminoglycoside (streptomycin or gentamicin) may be added, and the treatment duration may be extended to 3 months or longer.
From the Research
Recommended Dose of Rifampicin for Treating Brucellosis
The recommended dose of rifampicin for treating brucellosis varies depending on the patient population and the specific treatment regimen.
- For adult patients, the dose of rifampicin is typically 900 mg per day, given orally for 45 days, in combination with doxycycline 2, 3.
- For children under 8 years old, the recommended regimen is rifampicin plus cotrimoxazole for 45 days 2, 3.
- For pregnant women, rifampicin 900 mg once daily for 6 weeks is considered the drug of choice for treating brucellosis 2.
- The dose and duration of rifampicin may need to be adjusted based on the severity of the disease, the presence of complications, and the patient's response to treatment.
Treatment Regimens
Different treatment regimens for brucellosis have been studied, including:
- Doxycycline plus rifampicin for 45 days 2, 3
- Doxycycline plus streptomycin for 14 days 2
- Rifampicin plus cotrimoxazole for 45 days 2, 3
- Monotherapy with doxycycline for 45 days 2
- Rifampicin alone for 30 to 60 days 4
Important Considerations
- The treatment of brucellosis should be individualized based on the patient's specific needs and circumstances.
- The choice of treatment regimen should be based on the presence of focal disease and underlying conditions that may contraindicate certain antibiotics.
- The duration of treatment should be sufficient to prevent relapse and complications.
- Combination therapy with two or more antibiotics is often recommended to improve treatment outcomes and reduce the risk of relapse 5, 2, 3.