From the Guidelines
The recommended treatment for Brucellosis with positive IgG and IgM antibody tests is a combination antibiotic regimen consisting of doxycycline 100 mg twice daily for 6 weeks plus either rifampin 600-900 mg daily for 6 weeks or streptomycin 1 g daily intramuscularly for 2-3 weeks. This treatment approach is based on the Ioannina recommendations, which suggest that the optimal treatment of uncomplicated brucellosis should be based on a six-week regimen of doxycycline combined with either streptomycin for 2–3 weeks or rifampicin for six weeks 1.
For complicated cases involving neurobrucellosis or endocarditis, a triple therapy may be necessary, adding a third agent such as trimethoprim-sulfamethoxazole or an aminoglycoside, with treatment extended to 3-6 months. The choice of treatment regimen should be based on the severity of the disease, the presence of complications, and the patient's overall health status.
Some key points to consider when treating brucellosis include:
- The importance of prompt treatment initiation, as positive IgM indicates acute infection while IgG may reflect either current infection or past exposure 1
- The need for close monitoring for side effects, particularly gastrointestinal issues with doxycycline and hepatotoxicity with rifampin
- The importance of completing the full course of antibiotics even after symptoms resolve to prevent relapse
- The potential use of gentamicin as an alternative to streptomycin, although the duration of gentamicin treatment should be further evaluated in future randomized control trials 1
Overall, the treatment of brucellosis requires a comprehensive approach that takes into account the severity of the disease, the presence of complications, and the patient's overall health status. By following the Ioannina recommendations and considering the key points outlined above, healthcare providers can provide effective treatment for patients with brucellosis and improve outcomes.
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 Brucellosis with positive IgG and IgM antibody tests is streptomycin as a second-line agent.
- The dosage for adults is 1 to 2 grams in divided doses every six to twelve hours for moderate to severe infections, with a maximum of 2 grams per day.
- The dosage for children is 20 to 40 mg/kg/day in divided doses every 6 to 12 hours. 2
From the Research
Treatment of Brucellosis with Positive IgG and IgM Antibody Tests
- The treatment of brucellosis typically involves a combination of antibiotics to prevent the emergence of resistance 3, 4, 5.
- The World Health Organization (WHO) recommends the use of doxycycline with rifampicin or an aminoglycoside for brucellosis 6.
- However, some studies suggest that doxycycline plus streptomycin may be more effective than doxycycline plus rifampicin in treating brucellosis 4.
- Other combinations, such as doxycycline-rifampin-amikacin, have also been shown to be effective in treating brucellosis 7.
- The choice of treatment regimen may depend on various factors, including the severity of the disease, the presence of complications, and the patient's overall health status.
Antibiotic Regimens for Brucellosis
- Doxycycline plus rifampicin: This is a commonly used regimen for treating brucellosis, but it may not be the most effective option 3, 4.
- Doxycycline plus streptomycin: This regimen has been shown to be more effective than doxycycline plus rifampicin in some studies 4.
- Doxycycline-rifampin-amikacin: This combination has been shown to be effective in treating brucellosis, particularly in cases where the disease is severe or complicated 7.
- Doxycycline plus co-trimoxazole: This regimen has been shown to be as effective as doxycycline/rifampicin in non-focal brucellosis and may be preferred in countries with a high prevalence of tuberculosis 6.