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Oral fluoroquinolones for maintenance treatment of melioidosis
W Chaowagul1, Y Suputtamongkul, M D Smith
1Department of Medicine, Sappasitprasong Hospital, Ubon Ratchatani, Thailand.
Abstract:
Ciprofloxacin (20 mg/kg/d) or ofloxacin (12 mg/kg/d) given for a median of 15 weeks (range 12-40) were used for maintenance treatment of 57 adult patients with melioidosis. The median duration of follow-up in the 45 patients who complied with treatment and were followed for at least 6 months was 28 months (range 6-65). Fluoroquinolone treatment was well tolerated. There were 13 treatment failures (5 failures to respond, 8 relapses), a failure rate of 29% (95% confidence interval 17-43%). The median time to treatment failure was 7 months (range 2-26). These results are inferior to those with courses lasting 20 weeks of amoxycillin/clavulanic acid or the combination of chloramphenicol, doxycycline and trimethoprim/sulphamethoxazole, and suggest that the fluoroquinolones should be reserved as third line agents, and not used for the maintenance treatment of melioidosis unless there is resistance to, or intolerance of, the other available antimicrobial compounds.
Insights
Fluoroquinolone maintenance therapy for melioidosis showed a 29% failure rate, with ciprofloxacin and ofloxacin proving less effective than other treatments. These antibiotics should be reserved for cases with resistance or intolerance to standard melioidosis therapies.
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Melioidosis is a serious bacterial infection caused by Burkholderia pseudomallei.
- Effective treatment regimens are crucial for patient outcomes.
- Maintenance therapy plays a key role in preventing relapse.
Purpose of the Study:
- To evaluate the efficacy and safety of fluoroquinolones (ciprofloxacin and ofloxacin) as maintenance treatment for adult melioidosis patients.
- To compare fluoroquinolone efficacy with established melioidosis treatment protocols.
Main Methods:
- A study involving 57 adult melioidosis patients receiving maintenance treatment with ciprofloxacin (20 mg/kg/d) or ofloxacin (12 mg/kg/d) for a median of 15 weeks.
- Follow-up data collected for 45 patients who adhered to treatment for at least 6 months, with a median follow-up of 28 months.
- Treatment failure defined as failure to respond or relapse.
Main Results:
- Fluoroquinolone treatment was generally well-tolerated.
- A significant treatment failure rate of 29% (13 of 57 patients) was observed, including 5 failures to respond and 8 relapses.
- The median time to treatment failure was 7 months.
Conclusions:
- Fluoroquinolone maintenance therapy for melioidosis demonstrated a high failure rate (29%), indicating inferior efficacy compared to longer courses of amoxicillin/clavulanate or combination therapies.
- These findings suggest that fluoroquinolones should be considered third-line agents for melioidosis maintenance treatment.
- Reserve fluoroquinolones for patients with documented resistance or intolerance to first- and second-line antimicrobial agents.