Imipenem for the treatment of melioidosis

Melioidosis is a protean disease caused by Burkholderia pseudomallei. It is rare in the UK and is generally only seen in patients with a travel histor y to endemic areas such as Thailand, Singapore and Malaysia. Cases may pres ent with disseminated bacteraemic, non-disseminated bacteraemic, multi-foca l bacteraemic or localized disease. Subclinical infections also occur. Foll owing acquisition of the organism a patient may remain asymptomatic for sev eral years before infection becomes clinically apparent. Factors such as di abetes, renal failure or other causes for a decrease in host immunity may p recipitate the appearance of overt disease. The current treatment choice fo r severe melioidosis is parenteral ceftazidime followed by oral amoxycillin -clavulanic acid or a combination of co-trimoxazole, doxycycline and chlora mphenicol. We report a case of melioidosis in a 59-year-old male diabetic f rom Bangladesh who initially responded to piperacillin-tazobactam but was c hanged to ceftazidime when a definitive diagnosis was made. His condition d eteriorated on the latter antibiotic. He subsequently responded to imipenem . The patient's long-term outcome is still not known. (C) 1999 Elsevier Sci ence B.V. and International Society of Chemotherapy. All rights reserved.