Death from brucellosis is rare, occurring in no more than 2% of all cases. Generally, the antibiotics doxycycline and rifampin are recommended in combination for a minimum of 6-8 weeks.
Treatment options include doxycycline 100 mg twice a day for 45 days, plus streptomycin 1 g daily for 15 days. The main alternative therapy is doxycycline at 100 mg, twice a day for 45 days, plus rifampicin at 15mg/kg/day (600-900mg) for 45 days.
Chronic brucellosis is treated with triple-antibiotic therapy. The combination of rifampin, doxycycline, and streptomycin often is used.
Drugs that display clinical activity with low relapse rates include doxycycline, gentamicin, streptomycin, rifampin, and trimethoprim-sulfamethoxazole (TMP-SMZ). Other agents with potential roles are chloramphenicol, imipenem-cilastatin, and various fluoroquinolones.
2.1.
There is strong evidence that the tetracyclines (especially doxycycline and minocycline) are the most effective drugs for brucellosis treatment. The rate of treatment failure in tetracyclines is 1–5 %, the relapse rate is 5–10 % and the cure rate exceeds 80 % when an appropriate duration is used [4, 6].
Death from brucellosis is rare, occurring in no more than 2% of all cases. Generally, the antibiotics doxycycline and rifampin are recommended in combination for a minimum of 6-8 weeks.
Doxycycline plus ciprofloxacin was the most active combination in vitro. Conclusion: Routine susceptibility testing of Brucellae is not obligatory as most of the 'traditional' anti-Brucella antibiotics are active in vitro and bactericidal efficacy may differ in vivo.
In a murine model of brucellosis, azithromycin that was administered orally for 10 days reduced the infection significantly, but it was not able to cure the animals as effectively as doxycycline that was administered for a longer period [10].
Many reports have indicated that Brucella species are readily killed by most of the commonly available disinfectants including hypochlorite solutions, 70% ethanol, isopropanol, iodophores, phenolic disinfectants, formaldehyde, glutaraldehyde and xylene [5,10].
Brucellosis can be diagnosed in a laboratory by finding bacteria in samples of blood, bone marrow or other bodily fluids. Serological tests can also be done to detect antibodies against the bacteria.
Doctors usually confirm a diagnosis of brucellosis by testing blood or bone marrow for the brucella bacteria or by testing blood for antibodies to the bacteria.
CDC utilizes a test called the Brucella microagglutination test (BMAT), a modified version of the serum (tube) agglutination test (SAT), that can detect antibodies to Brucella species – abortus, melitensis or suis. There is no serological test available to detect antibodies to B. canis.
Ciprofloxacin and rifampicin treatment for brucellosis is as effective as the standard regimen of doxycycline and rifampicin and offers the advantage of a shorter duration of treatment.
Conclusions: Adding levofloxacin to the dual therapy for acute/subacute brucellosis (doxycycline-rifampin) may increase its efficacy in terms of lowering the relapse rate of the disease. Further, larger scale studies are needed before considering modifying the standard, dual therapy for brucellosis.
Azithromycin has an average rating of 6.8 out of 10 from a total of 1284 ratings on Drugs.com. 56% of reviewers reported a positive effect, while 21% reported a negative effect. Doxycycline has an average rating of 6.4 out of 10 from a total of 1608 ratings on Drugs.com.
Brucellosis can affect almost any part of your body, including your reproductive system, liver, heart and central nervous system. Chronic brucellosis may cause complications in just one organ or throughout your body. Possible complications include: Inflammation of the inner lining of the heart chambers (endocarditis).
Interactions between your drugs
No interactions were found between azithromycin and doxycycline.
Optimal treatment usually requires 2 antibiotics—doxycycline or trimethoprim/sulfamethoxazole plus gentamicin, streptomycin, or rifampin. The causative organisms of human brucellosis are B.
Highlights. Ciprofloxacin is effective in inhibiting Klebsiella pneumoniae ESBL and non-ESBL. Increasing the dose of antibiotics inhibits the growth of Klebsiella pneumoniae. Ciprofloxacin is more effective than cotrimoxazole and doxycycline in Klebsiella pneumoniae.
Adding levofloxacin to the WHO-recommended, dual antimicrobial therapy for acute/subacute brucellosis (doxycycline–rifampin) may increase its efficacy in the terms of lowering relapse rates within six months after stopping therapy. However, it had no effect on the rate of therapeutic failure after six weeks of therapy.
Ceftriaxone represents a reasonable option for the treatment of complicated brucellosis when added to the initial regimen at a dose of 2 g IV every 12 h.
Live attenuated Brucella abortus strain 19 (S19 vaccine) is the first effective and most extensively used vaccine for the prevention of brucellosis in cattle.