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A multicenter therapeutic study of 1100 children with brucellosis
M M Lubani1, K I Dudin, D C Sharda
1Pediatrics Department, Farwania Hospital, Kuwait.
Insights
For children with brucellosis, oral therapies like oxytetracycline, doxycycline, and rifampin showed low relapse rates. Combined oral therapies and those with injectable aminoglycosides were also effective, unlike trimethoprim-sulfamethoxazole alone.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Therapy Research
Background:
- Brucellosis remains a significant pediatric health concern globally.
- Optimizing antibiotic regimens for pediatric brucellosis is crucial to minimize relapses and treatment failures.
Purpose of the Study:
- To compare the efficacy of various oral antibiotic combinations and treatment durations for pediatric brucellosis.
- To evaluate the impact of adjunctive intramuscular aminoglycosides on treatment outcomes.
Main Methods:
- A 6-year multicenter study randomized 1100 children with brucellosis.
- Oral antibiotics (oxytetracycline, doxycycline, rifampin, trimethoprim-sulfamethoxazole) were used alone or in combination.
- Treatment durations varied (3, 5, or 8 weeks), with some receiving streptomycin or gentamicin injections.
Main Results:
- Oral monotherapy with oxytetracycline, doxycycline, or rifampin showed low relapse rates (≤9%) across all durations.
- Trimethoprim-sulfamethoxazole monotherapy had a high relapse rate (30%).
- Combined oral therapies (rifampin/oxytetracycline, rifampin/TMP/SMX, oxytetracycline/TMP/SMX) and regimens with aminoglycosides demonstrated very low relapse rates.
Conclusions:
- Oxytetracycline, doxycycline, and rifampin are effective oral monotherapies for pediatric brucellosis.
- Combined oral antibiotic regimens and those including aminoglycosides offer excellent outcomes with minimal relapses.
- Trimethoprim-sulfamethoxazole monotherapy is not recommended for pediatric brucellosis.
Abstract:
A 6-year multicenter therapeutic study was performed on 1100 children with brucellosis in order to compare several antibiotic combinations and duration of treatment. The patients were randomized to receive oral therapy with oxytetracycline, doxycycline, rifampin and trimethoprim-sulfamethoxazole (TMP/SMX) either alone or in combination with each other or combined with streptomycin or gentamicin injections. The patients were also randomized into three groups based on the duration of oral therapy: 500 patients were treated for 3 weeks; 350 for 5 weeks; and 250 for 8 weeks. When intramuscular aminoglycosides were used, streptomycin was given for 2 weeks and gentamicin for 5 days. In oral monotherapy oxytetracycline, doxycycline and rifampin showed comparable results with low relapse rates (less than or equal to 9%) and no statistically significant differences were found among 3-, 5- or 8-week durations of therapy. TMP/SMX alone showed an unacceptably high relapse rate (30%) with all durations of therapy. In combined oral therapy rifampin plus oxytetracycline, rifampin plus TMP/SMX and oxytetracycline plus TMP/SMX showed comparable results with low relapse rates ranging from 4 to 8% in patients receiving therapy for 3 or 5 weeks, no relapses occurred in patients treated for 8 weeks. When oral monotherapy was combined with either streptomycin or gentamicin, very few relapses were seen, irrespective of the duration of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)