DOXYCYCLINE-RIFAMPIN VERSUS DOXYCYCLINE-STREPTOMYCIN IN TREATMENT OF HUMAN BRUCELLOSIS DUE TO BRUCELLA-MELITENSIS

Brucellosis is a common zoonosis in many parts of the world; the best regimen for the treatment of brucellosis has not been clearly determin ed, We have carried out a multicenter, open, controlled trial in five general hospitals in Spain to compare the efficacy and safety of doxyc ycline and rifampin (DR) versus doxycycline and streptomycin (DS) for the treatment of human brucellosis. The study included 194 ambulatory or hospitalized patients,vith acute brucellosis, without endocarditis or neurobrucellosis. The diagnostic criterion was isolation of Brucell a species from blood or other tissues (n = 120) or a standard tube agg lutination titer of 1/160 or more for anti-Brucella antibodies with co mpatible clinical findings (n = 74). Patients were randomly assigned t o receive either 100 mg of doxycycline twice daily plus rifampin, 900 mg/day, in a single morning dose for 45 days (DR group) or the same do se of doxycycline for 45 days plus streptomycin, 1 g/day, intramuscula rly for 14 days (DS group), A tack of therapeutic efficacy developed i n 8 of the 100 patients in the DR group (8%) and in 2 of the 94 patien ts in the DS group (2%) (P = 0.10). Relapses occurred in 16 of the 100 patients in the DR group (16%) but in only 5 of the 94 patients in th e DS group (5.3%) (P = 0.02), When relapse was considered in combinati on with initial lack of efficacy, 26 patients in the DR group (24%) an d 7 patients in the DS group (7.45%) failed to respond to therapy (P = 0.0016), In general, therapy was well tolerated, and only four patien ts (4%) in the DR group and two (2%) in the DS group had episodes of a dverse effects necessitating discontinuation of treatment (P > 0.2). W e conclude that a doxycycline-and-rifampin regimen is less effective t han the doxycycline-and-streptomycin regimen in patients with acute br ucellosis.