Antimicrobial agents and Burkholderia pseudomallei: perspectives from Thailand

Abstract

Background: Burkholderia pseudomallei are the causative agent of melioidosis, a potentially life-threatening disease in humans and animals. It is a common public health threat in parts of Thailand. Objective: To summarizes the current knowledge regarding antimicrobial agents and B. pseudomallei. Methods: A literature search using MEDLINE (PubMed), SCOPUS, and OVID/LWWW databases. Results: B. pseudomallei are intrinsically resistant to a wide range of antimicrobial agents including β-lactam antibiotics, aminoglycosides, and macrolides. Antimicrobial therapy for melioidosis is divided into an acute phase and an eradication phase. The current recommendations for the acute phase are parenteral antimicrobial agents for ≥10 days using ceftazidime or a carbapenem. The eradication phase involves oral antimicrobial agents for ≥180 days using trimethoprim-sulfamethoxazole. Amoxicillin-clavulanic acid may be used as an alternative. Ceftazidime revealed rare primary resistance and a high relapse rate. Conclusion: Patients with acute melioidosis usually need intensive care and appropriate antibiotics for the acute and eradication phases. Ceftazidime is remains an effective agent in Thailand. A trend for decreasing susceptibility to antibiotics requires monitoring.