Treatment Melioidosis

1 treatment

1.1 current treatment
1.2 surgical treatment
1.3 historical treatment

treatment
current treatment

the treatment of melioidosis divided 2 stages, intravenous high-intensity phase , eradication phase prevent recurrence.

intravenous intensive phase
intravenous ceftazidime current drug of choice treatment of acute melioidosis , should administered 10 14 days after getting infection. meropenem, imipenem , cefoperazone-sulbactam combination (sulperazone) active. intravenous amoxicillin-clavulanate (co-amoxiclav) may used if none of above 4 drugs available, produces inferior outcomes. intravenous antibiotics given minimum of 10 14 days, , not stopped until patient s temperature has returned normal more 48 hours. appropriate antibiotic therapy, fevers persist weeks or months, , patients may continue develop new lesions while on appropriate treatment. median fever clearance time in melioidosis 10 days: , failure of fever clear not reason alter treatment. not uncommon patients require parenteral treatment continuously month or more.


intravenous meropenem routinely used in australia; outcomes appear , meropenem being tested ceftazidime in thai clinical trial.


theoretical reasons given believing mortality might lower in patients treated imipenem: first, less endotoxin released dying bacteria during imipenem treatment, , minimum inhibitory concentration (mic) imipenem lower ceftazidime. however, no clinically relevant difference found in mortality between imipenem , ceftazidime treatments. mic of meropenem higher b. pseudomallei many other organisms, , patients being haemofiltered need more frequent or higher doses.


moxifloxacin, cefepime, tigecycline, , ertapenem not appear effective in vitro. piperacillin-sulbactam, doripenem , biapenem appear effective in vitro, no clinical experience exists on recommend use.


adjunctive treatment granulocyte colony-stimulating factor or co-trimoxazole not associated decreased fatality rates in trials in thailand.


eradication phase
following treatment of acute disease, eradication (or maintenance) treatment co-trimoxazole , doxycycline recommended used 12 20 weeks reduce rate of recurrence. chloramphenicol no longer routinely recommended purpose. co-amoxiclav alternative patients unable take co-trimoxazole , doxycycline (e.g., pregnant women , children under age of 12), not effective. single agent treatment fluoroquinolone (e.g., ciprofloxacin) or doxycycline oral maintenance phase ineffective.


in australia, co-trimoxazole used on own eradication therapy, relapse rates lower seen in thailand; in vitro evidence suggests co-trimoxazole , doxycycline antagonistic, , co-trimoxazole on own may preferable. results randomised controlled trial (merth) support use of co-trimoxazole alone. studies reinforce need adequate follow-up , adherence eradication phase of therapy. dosing co-trimoxazole based on weight: (<40 kg: 160/800 mg every 12 hours; 40–60kg: 240/1200 mg every 12 hours, >60 kg: 320/1600 mg every 12 hours).

surgical treatment

surgical drainage indicated prostatic abscesses , septic arthritis, may indicated parotid abscesses, , not indicated hepatosplenic abscesses. in bacteraemic melioidosis unresponsive intravenous antibiotic therapy, splenectomy has been attempted, anecdotal evidence supports practice.

historical treatment

prior 1989, standard treatment acute melioidosis three-drug combination of chloramphenicol, co-trimoxazole , doxycycline; regimen associated mortality rate of 80% , no longer used unless no other alternatives available. 3 drugs bacteriostatic (they stop bacterium growing, not kill it) , action of co-trimoxazole antagonizes both chloramphenicol , doxycycline.