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Evidence summaries

Antibiotics for Treating Human Brucellosis

For patients with brucellosis, doxycycline (six weeks) plus streptomycin (two or three weeks) regimen appears to be more effective than doxycycline plus rifampicin (six weeks) regimen. Quinolone plus rifampicin (six weeks) regimen may be slightly better tolerated than doxycycline plus rifampicin. Level of evidence: "B"

The quality of evidence is downgraded by study limitations (lack of blinding).

Summary

A Cochrane review [Abstract] 1 included 25 studies on patients with brucellosis. In comparisons of doxycycline plus rifampicin versus doxycycline plus streptomycin eight studies with 694 participants were found. For treatment failure, the doxycycline plus streptomycin regimen was more effective than doxycycline plus rifampicin regime (RR 1.91, 95% CI 1.07 to 3.42, seven studies, 567 participants), relapse (RR 2.39, 95% CI 1.17 to 4.86), and minor adverse drug reactions (RR 1.38, 95% CI 0.99 to 1.92). In comparisons of doxycycline plus rifampicin against quinolone (ciprofloxacin or ofloxacin) plus rifampicin five studies of 336 participants were found. The pooled analysis did not demonstrate any significant difference between two regimens in terms of relapse and symptom persistence, but showed a non-significant higher risk of minor adverse reactions in doxycycline plus rifampicin (RR 1.80, 95% CI 0.78 to 4.18).

Clinical comments

Since streptomycin needs daily intramuscular (IM) injection, access to care and cost are important factors in deciding between two choices.

Note

Date of latest search: 2012-05-27

References

  • Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M et al. Antibiotics for treating human brucellosis. Cochrane Database Syst Rev 2012;10():CD007179. [PubMed]

Primary/Secondary Keywords