Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials

Abstract

Objectives To determine and quantify differences in efficacy between treatment regimens for brucellosis. Design Systematic review and meta-analysis of randomised controlled trials assessing different antibiotic regimens and durations of treatment for human brucellosis. Data sources PubMed, CENTRAL, Lilacs, conference proceedings, and bibliographies with no restrictions on language, study year, or publication status. Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality independently performed in duplicate. Primary outcomes were relapse and overall failure resulting from primary failure or relapse. Relative risks with 95% confidence intervals were calculated and pooled with a fixed effect model. Results 30 trials and 77 treatment arms were included. Overall failure was significantly higher with doxycyclinerifampicin compared to doxycycline-streptomycin, mainly due to a higher rate of relapse (relative risk 2.80, 95% confidence interval 1.81 to 4.36; 13 trials, without heterogeneity). Results were consistent among patients with bacteraemia and complicated brucellosis. Doxycycline-streptomycin resulted in a significantly higher rate of failure than doxycycline-rifampicinaminoglycoside (triple drug regimen) (2

Guidelines for the management of human brucellosis in the State of Paraná, Brazil

“…Therefore, at least two drugs should be used for the treatment of brucellosis (AI). Thirteen studies comparing tetracycline associated with rifampin and tetracycline associated with gentamycin showed superiority of treatment with aminoglycosides (AII) 25 . These findings were confirmed by two more systematic reviews 26,27 .…”

A rare case ofBrucella abortusendocarditis in South Africa

“…Dual or triple therapy comprising doxycycline plus aminoglycoside with or without rifampicin is the preferred regime that results in a decreased relapse and failure rate. 14,15 In order to make the diagnosis of Brucella endocarditis, there should be good communication between the clinician and the microbiologist in order for optimal culture methods to be undertaken. Brucella endocarditis should be suspected in patients who have had contact with farm animals, even in an area with a low prevalence of the disease.…”

An old foe still with us: Troubling issues with brucellosis

“…Monotherapy is not recommended because of its high recurrence rate. The most commonly used treatment regimen is doxycycline plus rifampin combination for 6 weeks (20). Triple-drug regimen should be preferred initially in special cases such as neurobrucellosis, endocarditis, and osteoarticular involvement.…”