RECOGNITION AND OPTIMUM TREATMENT OF BRUCELLOSIS

Brucellosis (infection with Brucella spp.) is a com mon zoonosis in ma ny parts of the world. Human brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. Treatme nt of brucellosis must effectively control acute illness and prevent c omplications and relapse. The choice of regimen and duration of antimi crobial therapy should be based on the presence of focal disease and u nderlying conditions which contraindicate certain specific antibiotics . The regimen of first choice is combination therapy with doxycycline for 45 days and streptomycin for 14 days. Gentamicin or netilmicin for the first 7 days may be substituted for streptomycin. Second-choice r egimens consist of combinations of doxycycline and rifampicin (rifampi n) for 45 days, or monotherapy with doxycycline for 45 days. Surgery s hould be considered for patients with endocarditis, cerebral or epidur al abscess, spleen abscess or other abscesses which are antibiotic-res istant. Tetracyclines are generally contraindicated for pregnant patie nts and children < 8 years old. Rifampicin 900mg once daily for 6 week s is considered the drug of choice for treating brucellosis in pregnan t women. In children < 8 years old the preferred regimen is rifampicin with cotrimoxazole (trimethoprim-sulfamethoxazole) for 45 days. An al ternative regimen consists of a combination of rifampicin for 45 days with gentamicin 5 to 6 mg/kg/day for the first 5 days.