A prospective comparison of co-amoxiclav and the combination of chloramphenicol, doxycycline, and co-trimoxazole for the oral maintenance treatment of melioidosis.
An open randomized comparison of the oral 'conventional' regimen (combination of chloramphenicol, cotrimoxazole and doxycycline) and co-amoxiclav for the maintenance treatment of melioidosis was conducted in Ubon Ratchatani, north-eastern Thailand, between 1989 and 1992. The total antibiotic treatment duration was 20 weeks. Of 101 patients followed, 10 (10%; 95% confidence interval [CI] 4.9-17.5%) subsequently relapsed: 2 of 52 patients (4%) in the oral 'conventional' group, and 8 of 49 patients (16%) receiving oral co-amoxiclav. This compares with a relapse rate of 23% in our previous study of 8 weeks' total therapy. Only 50% of patients complied with the 20 weeks' treatment regimen and poor compliance proved the most significant risk factor for subsequent relapse (relative risk [RR] 4.9, 95% CI 1.2-20.3). Neither the presence of known underlying disease nor choice of initial parenteral treatment was significantly associated with a higher risk of relapse. Co-amoxiclav is safer and better tolerated, but may be less effective (RR of relapse 0.4, 95% CI 0.2-1.2) than the oral 'conventional' regimen. The minimum duration of total treatment with either regimen should be 12-20 weeks, depending on clinical progress.
Rajchanuvong
A
A
Department of Medicine, Sappasitprasong Hospital, Ubon Ratchatani, Thailand.
Chaowagul
W
W
Suputtamongkol
Y
Y
Smith
M D
MD
Dance
D A
DA
White
N J
NJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination; D002701:Chloramphenicol / Q000627:therapeutic use; D002969:Clavulanic Acids / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008554:Melioidosis / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D002969:Clavulanic Acids; D002701:Chloramphenicol; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline