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.
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.
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].
Two-drug regimen consisting of streptomycin and doxycycline (streptomycin for 2 to 3 weeks and doxycycline for 8 weeks) or gentamicin plus doxycycline (gentamicin for 5-7 days and doxycycline for 8 weeks) should be recommended as the treatment of choice for uncomplicated brucellosis.
The satisfactory effectiveness of rifampin is confirmed by a review of the literature which found 17 reports addressing the subject. These include 324 cases of brucellosis treated by rifampin, as sole therapy in 255 patients, with only 24 failures ascribable to faulty dosage.
Rifampin should not be used to treat people who have developed symptoms of meningitis. Rifampin is in a class of medications called antimycobacterials. It works by killing the bacteria that cause infection. Antibiotics such as rifampin will not work for colds, flu, or other viral infections.
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. To help detect complications of brucellosis, your doctor may order additional tests, including: X-rays.
Treatment and care
The incubation period of the disease can be highly variable, ranging from 1 week to 2 months, but usually 2–4 weeks. Treatment options include doxycycline 100 mg twice a day for 45 days, plus streptomycin 1 g daily for 15 days.
Signs and symptoms of brucellosis may include fever, joint pain and fatigue. The infection can usually be treated with antibiotics. However, treatment takes several weeks to months, and the infection can recur.
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.
Doxycycline belongs to the class of medicines known as tetracycline antibiotics. It works by killing bacteria or preventing their growth. However, this medicine will not work for colds, flu, or other virus infections.
It typically takes 1 to 2 weeks for doxycycline to fully clear an infection, but some infections can take as long as 2 months. Since the time frame can be different for everyone, your healthcare provider can tell you more about what to expect. If you're taking doxycycline for acne, it can take a little longer.
The symptoms usually improve and are completely gone within about two to six months. However, the prognosis is poor in people who develop organ changes or complications such as heart damage, neurological, or genitourinary problems caused by chronic Brucella infection.
Ciprofloxacin can be considered as an alternative drug for the treatment of brucellosis, more effective (clinically and immunologically) than a combination of two antibiotics: doxycycline and rifampicin.
Brucellosis is an infectious disease caused by bacteria. People can get the disease when they are in contact with infected animals or animal products contaminated with the bacteria. Animals that are most commonly infected include sheep, cattle, goats, pigs, and dogs, among others.
Twenty-eight cases of acute brucellosis were diagnosed and confirmed by positive blood culture. They were treated with amoxycillin in a daily dosage of two capsules of 375 mg every eight hours. Treatment lasted for one month of which the first 15 days were spent in hospital.
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.
Symptoms and Signs of Brucellosis
Onset may be sudden, with chills and fever, severe headache, joint and low back pain, malaise, and occasionally diarrhea. Or onset may be insidious, with mild prodromal malaise, muscle pain, headache, and pain in the back of the neck, followed by a rise in evening temperature.
After acute brucellosis infection, symptoms persist in a minority of patients for more than 1 year. Such patients are defined as having chronic brucellosis. Since no objective laboratory methods exist to confirm the presence of chronic disease, these patients suffer delays in both diagnosis and treatment.
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.
Gentamicin is an aminoglycoside antibiotic that exerts a bacteriostatic effect by inhibiting protein synthesis through binding to 30S ribosomal subunits. It is commonly used to treat brucellosis in combination with either TMP-SMZ or doxycycline. Dosing regimens are numerous.
Negative to a titer of 1:40 or higher can be seen in the normal, healthy population. A titer of 1:80 or greater is often considered clinically significant(2); however, a 4-fold or greater increase in titer between acute and convalescent phase sera is required to diagnose acute infection.
An abnormal (positive) result usually means you have come in contact with the bacteria that causes brucellosis. However, this positive result does not mean that you have an active infection. Your provider will have you repeat the test after a few weeks to see if the test result increases.
In conclusion, brucella antibodies of 1:320 or higher can persist for more than 2 years after successful treatment and clinical cure. Re-evaluation of diagnostic titer of brucellosis is required in brucella-endemic countries.