A comparison of chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline with doxycycline alone as maintenance therapy for melioidosis

A prospective, open, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of the conventional four-drug combinati on (chloramphenicol, trimethoprimsulfamethoxazole, and doxycycline) with th at of doxycycline alone in oral maintenance treatment of melioidosis. Adult Thai patients with culture-confirmed melioidosis were randomized to receiv e treatment with either regimen for a minimum of 12 weeks, usually followin g intravenous treatment of severe disease. The main outcome measure was cul ture-confirmed relapse. One hundred sixteen patients were enrolled; 109 had culture-confirmed melioidosis, and 87 were considered evaluable (43 had re ceived doxycycline), Culture-confirmed relapse occurred in one patient rand omized to the conventional regimen and in 11(25.6%) randomized to the doxyc ycline regimen (P = .009), and treatment failed for 8 (18.2%) versus 20 (46 .5%), respectively (P = .009), Adverse effects occurred in 26% of patients overall. Doxycycline alone cannot be recommended for a first-line regimen o f oral maintenance treatment of melioidosis.