infectious diseases
Brucellosis
Treatment of Brucellosis
Doxycyclineplus eitherrifampin, an aminoglycoside (streptomycinorgentamicin), orciprofloxacin Activity should be restricted in acute cases of brucellosis, with bed rest recommended during febrile episodes. Severe musculoskeletal pains, especially over the spine, may require analgesia.Brucellaendocarditis often requires surgery in addition to antibiotic therapy. If antibiotics are given, combination therapy is preferred because relapse rates with monotherapy are high. Oraldoxycycline100 mg 2 times a day for 6 weeks plusstreptomycin1 g IM every 12 to 24 hours (orgentamicin3 mg/kg IV once a day) for 14 days lowers the rate of relapse. For uncomplicated cases, oralrifampin600 to 900 mg 2 times a day for 6 weeks can be used instead of an aminoglycoside. Regimens using oralciprofloxacin500 mg 2 times a day for 14 to 42 days plusrifampinordoxycyclineinstead of an aminoglycoside have been shown to be equally effective. In children<8 years,trimethoprim/sulfamethoxazole (TMP/SMX) and oralrifampinfor 4 to 6 weeks have been used. Neurobrucellosis and endocarditis require prolonged treatment. Even with antibiotic treatment, about 5 to 15% of patients relapse, so all should be followed clinically and with repeat serologic titers for 1 year. 