title: Imipenem for the treatment of melioidosis.
abstract: Melioidosis is a protean disease caused by Burkholderia pseudomallei. It is rare in the UK and is generally only seen in patients with a travel history to endemic areas such as Thailand, Singapore and Malaysia. Cases may present with disseminated bacteraemic, non-disseminated bacteraemic, multi-focal bacteraemic or localized disease. Subclinical infections also occur. Following acquisition of the organism a patient may remain asymptomatic for several years before infection becomes clinically apparent. Factors such as diabetes, renal failure or other causes for a decrease in host immunity may precipitate the appearance of overt disease. The current treatment choice for severe melioidosis is parenteral ceftazidime followed by oral amoxycillin-clavulanic acid or a combination of co-trimoxazole, doxycycline and chloramphenicol. We report a case of melioidosis in a 59-year-old male diabetic from Bangladesh who initially responded to piperacillin-tazobactam but was changed to ceftazidime when a definitive diagnosis was made. His condition deteriorated on the latter antibiotic. He subsequently responded to imipenem. The patient's long-term outcome is still not known.
authors.affiliation: Department of Medical Microbiology, London Hospital Medical College, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Minassian
authors.forename: A
authors.initials: A
authors.lastname: Gage
authors.forename: E
authors.initials: E
authors.lastname: Price
authors.forename: A M
authors.initials: AM
authors.lastname: Sefton
mesh_terms: D016957:Burkholderia pseudomallei / Q000187:drug effects; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D008297:Male; D008554:Melioidosis / Q000188:drug therapy*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013845:Thienamycins / Q000627:therapeutic use*
chemical_list: D013845:Thienamycins; D015378:Imipenem