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Treatment and prophylaxis of melioidosis.
Int J Antimicrob Agents. 2014 Apr; 43(4):310-8.IJ

Abstract

Melioidosis, infection with Burkholderia pseudomallei, is being recognised with increasing frequency and is probably more common than currently appreciated. Treatment recommendations are based on a series of clinical trials conducted in Thailand over the past 25 years. Treatment is usually divided into two phases: in the first, or acute phase, parenteral drugs are given for ≥10 days with the aim of preventing death from overwhelming sepsis; in the second, or eradication phase, oral drugs are given, usually to complete a total of 20 weeks, with the aim of preventing relapse. Specific treatment for individual patients needs to be tailored according to clinical manifestations and response, and there remain many unanswered questions. Some patients with very mild infections can probably be cured by oral agents alone. Ceftazidime is the mainstay of acute-phase treatment, with carbapenems reserved for severe infections or treatment failures and amoxicillin/clavulanic acid (co-amoxiclav) as second-line therapy. Trimethoprim/sulfamethoxazole (co-trimoxazole) is preferred for the eradication phase, with the alternative of co-amoxiclav. In addition, the best available supportive care is needed, along with drainage of abscesses whenever possible. Treatment for melioidosis is unaffordable for many in endemic areas of the developing world, but the relative costs have reduced over the past decade. Unfortunately there is no likelihood of any new or cheaper options becoming available in the immediate future. Recommendations for prophylaxis following exposure to B. pseudomallei have been made, but the evidence suggests that they would probably only delay rather than prevent the development of infection.

Authors+Show Affiliations

Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK. Electronic address: david.d@tropmedres.ac.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

24613038

Citation

Dance, David. "Treatment and Prophylaxis of Melioidosis." International Journal of Antimicrobial Agents, vol. 43, no. 4, 2014, pp. 310-8.
Dance D. Treatment and prophylaxis of melioidosis. Int J Antimicrob Agents. 2014;43(4):310-8.
Dance, D. (2014). Treatment and prophylaxis of melioidosis. International Journal of Antimicrobial Agents, 43(4), 310-8. https://doi.org/10.1016/j.ijantimicag.2014.01.005
Dance D. Treatment and Prophylaxis of Melioidosis. Int J Antimicrob Agents. 2014;43(4):310-8. PubMed PMID: 24613038.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment and prophylaxis of melioidosis. A1 - Dance,David, Y1 - 2014/02/03/ PY - 2014/01/10/received PY - 2014/01/11/accepted PY - 2014/3/12/entrez PY - 2014/3/13/pubmed PY - 2015/1/13/medline KW - Antibiotics KW - Burkholderia pseudomallei KW - Melioidosis KW - Prophylaxis KW - Treatment SP - 310 EP - 8 JF - International journal of antimicrobial agents JO - Int J Antimicrob Agents VL - 43 IS - 4 N2 - Melioidosis, infection with Burkholderia pseudomallei, is being recognised with increasing frequency and is probably more common than currently appreciated. Treatment recommendations are based on a series of clinical trials conducted in Thailand over the past 25 years. Treatment is usually divided into two phases: in the first, or acute phase, parenteral drugs are given for ≥10 days with the aim of preventing death from overwhelming sepsis; in the second, or eradication phase, oral drugs are given, usually to complete a total of 20 weeks, with the aim of preventing relapse. Specific treatment for individual patients needs to be tailored according to clinical manifestations and response, and there remain many unanswered questions. Some patients with very mild infections can probably be cured by oral agents alone. Ceftazidime is the mainstay of acute-phase treatment, with carbapenems reserved for severe infections or treatment failures and amoxicillin/clavulanic acid (co-amoxiclav) as second-line therapy. Trimethoprim/sulfamethoxazole (co-trimoxazole) is preferred for the eradication phase, with the alternative of co-amoxiclav. In addition, the best available supportive care is needed, along with drainage of abscesses whenever possible. Treatment for melioidosis is unaffordable for many in endemic areas of the developing world, but the relative costs have reduced over the past decade. Unfortunately there is no likelihood of any new or cheaper options becoming available in the immediate future. Recommendations for prophylaxis following exposure to B. pseudomallei have been made, but the evidence suggests that they would probably only delay rather than prevent the development of infection. SN - 1872-7913 UR - https://www.unboundmedicine.com/medline/citation/24613038/Treatment_and_prophylaxis_of_melioidosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0924-8579(14)00018-1 DB - PRIME DP - Unbound Medicine ER -