The effectiveness of treatment of human brucellosis caused by Brucella melitensis with ciprofloxacin alone was investigated in a prospective nonrandomized study. Subjects with central nervous system involvement, endocarditis, or severe renal dysfunction; children under 16 years of age; and pregnant women were excluded from the study. Of 19 patients, 16 completed the study; 7 were diagnosed as having acute systemic brucellosis, and 9 had acute brucella arthritis-diskitis. A rapid response to ciprofloxacin was seen in all 16 patients, but the blood cultures of 1 patient remained positive and the treatment was changed. During a 104-week follow-up period, 4 of the 15 responding patients relapsed or were reinfected within 8 to 32 weeks after completion of therapy. We conclude that treatment with ciprofloxacin alone, although effective for the acute symptoms, is associated with an appreciable rate of relapse; therefore, it should be given with other agents for treatment of brucellosis.Brucellosis is a common illness in developing countries. The disease remains hyperendemic in Kuwait, Saudi Arabia, and the Mediterranean region. This is due to the prevalence of infected domestic animals in these regions: camels, goats, and sheep. The most effective, least toxic chemotherapy for human brucellosis is still undecided. Brucella melitensis is susceptible to a wide variety of antibiotics. In Saudi Arabia, the MICs and MBCs of streptomycin, gentamicin, and netilmicin are similar but there is an appreciable gap between the MICs and the MBCs of rifampin, tetracycline, and trimethoprim-sulfamethoxazole.Brucella species are facultative intracellular parasites; therefore, it is important to treat patients with antimicrobial agents which penetrate macrophages and are bactericidal. Ciprofloxacin is a broad-spectrum synthetic fluoroquinolone which inhibits the growth of gram-positive and gram-negative bacteria. High oral bioavailability, high concentration in tissue, and rapid bacterial killing make it attractive for the treatment of intracellular infections (4, 10, 13). In vitro studies have shown that all clinical isolates of B. melitensis tested prior to therapy were susceptible to ciprofloxacin (3,6,14
Pharmacy and Therapeutics Committee and the ResearchCommittee approved the study prior to its inception.Patients with central nervous system involvement or endocarditis were excluded from the study. Individuals who had received antimicrobial therapy after recognition of the initial symptoms, pregnant women, those under 16 years of age, those allergic to nalidixic acid or its derivatives, and those with severe renal dysfunction were also excluded.The diagnostic criteria used were isolation of Brucella species from blood or other tissues or fluids or positive serology, i.e., total agglutinating antibodies (agglutination titer, 1:640) in the presence of compatible clinical findings. Patients initially seen with acute onset of fever, chills, sweating, and malaise with positive brucella serology or positive brucella culture were defined...
