Comparison of the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks versus streptomycin for 2 weeks plus doxycycline for 45 days in the treatment of human brucellosis: a randomized clinical trial

Roushan, Mohammad Reza Hasanjani; Amiri, Mehrangiz; Janmohammadi, Nasser; Hadad, M. Sadeghi; Javanian, Mostafa; Baiani, Masomeh; Bijani, Ali

doi:10.1093/jac/dkq064

Cited by 27 publications

(23 citation statements)

References 21 publications

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“…6,[24][25][26][27][28] It is known that patients with Brucella infection may well be asymptomatic despite being proven by culture to be bacteremic. 29,30 Nonetheless, our present report reinforces the need for active surveillance and contact tracing after apparent point source outbreaks given the subclinical or early cases that are not identified in a timely manner because of non-specific symptoms. This outbreak also reinforces the need to consider different cultural issues regarding potential food point exposures in brucellosis transmission.…”

Section: Discussionsupporting

confidence: 61%

A Foodborne Outbreak of Brucellosis at a Police Station Cafeteria, Lima, Peru

Román¹,

Castillo²,

Gilman³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Brucella melitensis is highly infectious for humans and can be transmitted to humans in a number of epidemiological contexts. Within the context of an ongoing brucellosis surveillance project, an outbreak at a Peruvian police officer cafeteria was discovered, which led to active surveillance (serology, blood culture) for additional cases among 49 police officers who had also eaten there. The cohort was followed up to 18 months regardless of treatment or symptoms. Active surveillance estimated the attack rate at 26.5% (13 of 49). Blood cultures from four cases were positive; these isolates were indistinguishable using multiple locus variable number tandem repeat analysis. This investigation indicates the importance of case tracking and active surveillance for brucellosis in the context of potential common source exposure. These results provide rationale for public health investigations of brucellosis index cases including the bioterrorism-related dissemination of Brucella.

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Section: Discussionsupporting

confidence: 61%

A Foodborne Outbreak of Brucellosis at a Police Station Cafeteria, Lima, Peru

Román¹,

Castillo²,

Gilman³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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“…35 Since nearly 90% of relapses happened within 6 months after the completion of the treatment, follow-up of these patients is necessary after treatment to detect any relapse as soon as possible and to provide the sufficient therapy. 36,37 In the present study, five (10%) patients had relapse during the follow-up period and were positive by PCR, and had increased titers. Molecular detection of Brucella DNA can be a sign of acute or chronic brucellosis and may also be detected in asymptomatic subjects with a history of brucellosis.…”

Section: Discussionsupporting

confidence: 48%

Polymerase Chain Reaction–Based Assays for the Diagnosis of Active and Relapsed Cases of Human Brucellosis

Roushan

Marashi

Moulana

2016

The American Society of Tropical Medicine and Hygiene

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Abstract. This study aimed to compare polymerase chain reaction (PCR) with serum agglutination test (SAT) in the diagnosis of patients before and 6 months after treatment. Peripheral blood specimens from 50 patients with brucellosis (case group) and 30 subjects without brucellosis (control group) were selected and entered into the study. The diagnosis of brucellosis was established using SAT ≥ 1:160 and 2-mercaptoethanol (2-ME) ≥ 1:80 with clinical signs and symptoms compatible with brucellosis. For each case, both before treatment and 6 months after completion of therapy, SAT, 2-ME, and PCR were performed. Subjects in the control group were assessed by the same tests at the initial visit. In the case group, 50 patients (36 males, 14 females) with the mean age of 43.6 ± 14.5 years were evaluated. The mean age of the control group was 40.6 ± 14 years. Among the 50 patients whose nested PCR assays were initially positive, 43 (86%) were negative 6 months after completing treatment. Relapse occurred in five (10%) patients within 6 months after treatment and all were PCR positive. None of the patients in the control group was PCR positive. Results show that PCR seems to be highly sensitive and specific, and therefore is a useful method for both the initial diagnosis and detection of relapse or chronic brucellosis.

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“…The study with the highest rate of relapse and treatment failures combined was that by Ersoy et al published in 2005, with 12.8% [26]. One group of 4 studies used streptomycin for 3 weeks [11], [25], [26], [29] and a second group of 6 studies used streptomycin for 2 weeks [10], [17], [18], [20], [27], [28]. The overall percentage of relapse and treatment failure in the former was 6.9% (10 out of 145 patients), while in the latter was 7.5% (34 out of a total 452 patients) (p = 0.96).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

Pozo¹,

2012

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BackgroundBrucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance.Methods and FindingsA search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified.Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05–4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81–4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63–2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future.ConclusionsAlthough the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice.

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Comparison of the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks versus streptomycin for 2 weeks plus doxycycline for 45 days in the treatment of human brucellosis: a randomized clinical trial

Abstract: The results show that the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks is not superior to that of streptomycin for 2 weeks plus doxycycline for 45 days.

Cited by 27 publications

References 21 publications

A Foodborne Outbreak of Brucellosis at a Police Station Cafeteria, Lima, Peru

A Foodborne Outbreak of Brucellosis at a Police Station Cafeteria, Lima, Peru

Polymerase Chain Reaction–Based Assays for the Diagnosis of Active and Relapsed Cases of Human Brucellosis

Systematic Review and Meta-Analysis of Randomized Clinical Trials in the Treatment of Human Brucellosis

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