Trimethoprim-sulphamethoxazole in Acute Brucellosis

Hassan, Anwar; Erian, Mark; Farid, Z.; Hathout, S. D.; Sorensen, K

doi:10.1136/bmj.3.5767.159

Cited by 31 publications

(8 citation statements)

References 7 publications

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“…Tetracyclines are still the chemotherapeutic agents of choice in the treatment of brucellosis (Garrod et al, 1973) with the possible exception of co-trimoxazole (Hassan et al, 1971;Giunchi et al 1971). In this investigation we have found that the efficacy of the tetracyclines varies significantly in vitro.…”

Section: Discussionmentioning

confidence: 55%

Sensitivity of Brucella spp to tetracycline and its analogues.

Farrell¹,

Hinchliffe²,

Robertson³

1976

J Clin Pathol

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SYNOPSIS The sensitivity to eight tetracyclines of 100 strains of brucellae, comprising strains of Brucella abortus, Br. melitensis, and Br. suis, was determined. Demethylchlortetracycline was the most effective against all the groups of brucellae, whereas oxytetracycline and chlortetracycline were the least effective. The mean MIC value for demethylchlortetracycline, doxycycline, lymecycline, and tetracycline was < 1 ,ug/ml. Strains of Br. abortus biotype 2 and Br. suis were the most sensitive strains examined.Tetracyclines are the most effective of the chemotherapeutic agents in the treatment of brucellosis (Spink, 1964;Rizzo-Naudi et al, 1967). Robertson et al (1973) have shown that strains of Brucella abortus are almost uniformly sensitive to tetracycline, and the minimum inhibitory concentiation (MIC) values are between four and eight times less than the peak plasma levels. Steigbigel et al (1968), in an extensive study, found significant differences in the in-vitro antimicrobial activity of tetracycline and its various chemical analogues.In this investigation the sensitivity of strains of Br. abortus, Br. melitensis, and Br. suis were determined to tetracycline and seven of its analogues. The ditch plate method, described by Robertson et al (1973) as a suitable method for determining the MIC of various antibiotics to brucellae, was used after further preliminary investigation. Material and methods BRUCELLA STRAINSThe 100 strains of brucellae used in this study were isolated from human and animal sources. They were classified according to the criteria of Alton and Jones (1967) into 67 strains of Br. abortus, 23 strains of Br. melitensis, and 10 strains of Br. suis, and divided into their biotypes. The strains of Br. abortus were either isolated from cow's milk or cultured from the blood of patients with brucellosis in north-west Lancashire, the strains of Br. melitensis were isolated from patients infected abroad, and the strains of Br. suis were isolated from animal sources abroad. Received for publication 5 May 1976The strains were grown on serum-dextrose (SD) agar, prepared from blood agar base No. 2 (Oxoid) incorporating 5% horse serum and 1 % dextrose. All plates were incubated in air containing 10% CO2 at 37°C for three days. TETRACYCLINE SOLUTIONStock solutions of the following eight tetracyclines were prepared in 10% dimethylformamide (DMF): chlortetracycline, demethylchlortetracycline, doxycline, lymecycline, methacycline, minocycline, oxytetracycline, and tetracycline. They were obtained as powders of known potency from Mast Laboratories, Liverpool.The solutions were prepared as required and sterilized by membrane filtration. MINIMUM INHIBITORY CONCENTRATION OF THE CONTROL STRAINThe WHO prototype Br. abortus biotype 2 was used as the control strain and the MIC of each tetracycline was determined as follows:A series of two-fold dilutions of each of the tetracyclines was prepared in SD agar plates ranging from 4 ,tg/ml to 0-1 ,ug/ml. Control plates were prepared containing the highest proportion o...

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Section: Discussionmentioning

confidence: 55%

Sensitivity of Brucella spp to tetracycline and its analogues.

Farrell¹,

Hinchliffe²,

Robertson³

1976

J Clin Pathol

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“…Co-trimoxazole has been used in the treatment of acute and chronic brucellosis (La1 et al, 1970; Giunchi, de Rosa and Fabiani, 1971 ;Hassan et al, 1971). The results in acute infections are encouraging, although further clinical trials are necessary.…”

Section: Discussionmentioning

confidence: 94%

The Sensitivity of Brucella Abortus to Chemotherapeutic Agents

Robertson

Farrell

Hinchliffe

1973

Journal of Medical Microbiology

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MANY chemotherapeutic agents have been tried in the treatment of both acute and chronic brucellosis. It is generally accepted that tetracycline is the treatment of choice, but Spink (1964) suggested that in the more severe infections the simultaneous administration of streptomycin might be beneficial. Evidence for the synergistic action of tetracycline and streptomycin is incomplete, and most reports have been based on the treatment of small groups of patients. The main purpose of this investigation was to determine the sensitivity of strains of Brucella abortus to ampicillin, tetracycline and streptomycin by four different quantitative techniques. The sensitivity to carbenicillin, gentamicin, kanamycin and co-trimoxazole (a combination of sulphamethoxazole and trimethoprim) was also investigated. MATERIALS AND METHODSStrains of B. abortus. Twenty-five strains comprised five strains each of biotypes 1,2,4,5, and 9; all were recent isolates from human or bovine sources. The strains were maintained on serum-dextrose (SD) agar slopes (5 per cent. horse serum, 1 per cent. dextrose) and kept at 4OC. When required, they were subcultured onto 5 per cent. blood agar and incubated for 3 days at 37OC. Throughout this study, all cultures were incubated in air containing 10 per cent. C02. Sensitivity tests. Sensitivity to ampicillin, streptomycin and tetracycline was tested by the following methods : broth dilution (BD), agar dilution-heavy inoculum (ADHI), agar dilution-light inoculum (ADLI) and ditch. The strains were tested with carbenicillin, gentamicin and kanamycin by the ADHI and ditch methods.The possible synergistic effect of sulphamethoxazole and trimethoprim and of tetracycline and streptomycin was investigated. As a preliminary screening procedure, one strain of each biotype was seeded on to a SD plate in which two ditches had been cut at right angles; each ditch had been Wed with agar containing one of the pair of substances under test. Evidence of synergism was investigated further by the ADHI method. Lysed horse blood (5 per cent.) was added to the medium as recommended by Darrell, Garrod and Waterworth (1968) when sulphamethoxazole and trimethoprim were used. BD method. A 3-day serum-dextrose (SD) broth culture (Alton and Jones, 1967) of each strain was diluted 1 in 10 in sterile phosphatebuffered salinepH 7-2 (PBS). Two-fold dilutions of each antibiotic in SD broth were prepared and distributed in 2-ml amounts in sterile tubes.

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“…However, brucellae are highly sensitive to the combination of trimethoprim with sulphamethoxazole (co-trimoxazole) and this drug has been found to be very effective clinically in Br. melitensis infection provided treatment is continued for six weeks (Hassan et al, 1971). It was felt that in this patient prolonged antimicrobial therapy was indicated to protect the prosthetic valve which had been inserted in the presence of uncontrolled infection and that co-trimoxazole would therefore be easier to administer than the more traditional combination.…”

Section: Discussionmentioning

confidence: 98%

Brucella melitensis endocarditis: successful treatment of an infected prosthetic mitral valve

O'Meara

Eykyn

Jenkins

et al. 1974

Thorax

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. Brucelha melitensis endocarditis: successful treatment of an infected prosthetic mitral valve. A 38-year-old man had a mitral valve replacement for rheumatic calcific mitral stenosis and regurgitation; following this operation he remained well for 10 months. He then presented with cough, abdominal pain, and rigors, and Brucella melitensis type 3 was repeatedly isolated from blood cultures. His clinical condition deteriorated rapidly and an emergency valve replacement was performed. He was then treated with co-trimoxazole for 12 months and made an excellent recovery. This is the first reported case of brucella endocarditis arising de novo on a prosthetic heart valve. Endocarditis is a rare but serious complication of brucellosis. We report here a case of Brucella melitensis type 3 endocarditis occurring in a patient with a prosthetic mitral valve. CASE REPORTA 38-year-old Italian male restaurant proprietor underwent mitral valve replacement for rheumatic calcific mitral stenosis and regurgitation on 13 January 1972, with insertion of a No. 3 Starr Edwards mitral valve prosthesis type 6520. On the fourth day after the operation he developed a pyrexia with a rigor. Blood cultures taken at this time were sterile but it was known that at least one bottle of intravenous fluid he had received was contaminated with Pseudomonas thomasii (Phillips, Eykyn, and Laker, 1972) and he was accordingly treated with a six-week course of co-trimoxazole to which the organism was known to be sensitive. Following this, the patient made a good recovery and remained well for 10 months, requiring only routine maintenance doses of digoxin and warfarin.In November 1972, he developed a febrile illness with rigors and complained of cough and abdominal pain, and one week later he became progressively dyspnoeic on exertion and orthopnoeic. Blood was taken for culture and treatment was started with amoxycillin. However, his fever persisted and he developed left heart failure, requiring admission to St. Peter's Hospital, Chertsey on 21 November. Amoxycillin was discontinued and further blood cultures were taken. He was transferred to St. Thomas' Hospital on 25 November where more blood cultures were taken before treatment was begun with intravenous ampicillin and intramuscular streptomycin as it was considered that he had endocarditis. Two days later a slow-growing oxidase-positive Gram-negative bacillus was isolated from the blood cultures taken at Chertsey. It was strongly suspected that this organism might be Ps. thomasii and the antibiotic therapy was changed to intravenous cephalexin, trimethoprim, and sulphadiazine. However, the patient's condition deteriorated and cardiac catheterization with angiography was performed on 29 November. Right heart catheterization showed a right atrial mean pressure of 6 mmHg, pulmonary artery pressure of 40/28 mmHg, and pulmonary artery wedge pressure of 33/26 mmHg. Left heart catheterization showed an aortic pressure of 68/35 mmHg and a left ventricular pressure of 75/7 mmHg. Simultaneous pulmonary arter...

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Trimethoprim-sulphamethoxazole in Acute Brucellosis

Cited by 31 publications

References 7 publications

Sensitivity of Brucella spp to tetracycline and its analogues.

Sensitivity of Brucella spp to tetracycline and its analogues.

The Sensitivity of Brucella Abortus to Chemotherapeutic Agents

Brucella melitensis endocarditis: successful treatment of an infected prosthetic mitral valve

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