title: Serum bactericidal and inhibitory titres in the management of melioidosis.
abstract: A retrospective evaluation of the relationship between serum bactericidal and inhibitory titres and treatment outcome in 195 adult Thai patients with severe melioidosis was conducted. Drug regimens included ceftazidime (52% of patients), co-amoxiclav (24%), imipenem (11%) or the conventional four-drug combination (11%). Pre- and 1 h post-dose serum samples were collected after 48-72 h of therapy, and serum inhibitory and bactericidal titrations determined. Median post-dose titres were: bactericidal 1:8 (range 0-1:128) and inhibitory 1:16 (range 0-1:128). Overall mortality was 26% and outcome was not influenced by either inhibitory or bactericidal titres. Pre-dose titres correlated with renal function; renal function was the most important predictor of mortality. Determination of serum inhibitory or bactericidal titres is unhelpful in the management of severe melioidosis.
authors.affiliation: Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. fnajs@diamond.mahidol.ac.th
authors.forename: A J
authors.initials: AJ
authors.lastname: Simpson
authors.forename: D A
authors.initials: DA
authors.lastname: Dance
authors.forename: V
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D016957:Burkholderia pseudomallei / Q000187:drug effects*; D002442:Ceftazidime / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D015378:Imipenem / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use; D007677:Kidney Function Tests; D007902:Length of Stay; D008554:Melioidosis / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D015610:Serum Bactericidal Test; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem; D019980:Amoxicillin-Potassium Clavulanate Combination; D002442:Ceftazidime