Recent advances in the treatment of severe melioidosis.
For the last decade, high-dose intravenous ceftazidime has been the drug of choice for the treatment of severe melioidosis, after ceftazidime was shown to be superior to the 'conventional' four-drug regimen (chloramphenicol, doxycycline and trimethoprim-sulphamethoxazole) in a randomised trial. Combination ceftazidime-trimethoprim-sulphamethoxazole was compared with the conventional regimen in a separate trial with similar results, but we still do not know whether such combination therapy is needed in melioidosis. Co-amoxiclav (amoxycillin-clavulanate) has been shown to be effective but was associated with a higher rate of treatment failure than ceftazidime. Two further treatment trials in acute melioidosis have recently been conducted in Thailand. In the first of these, high-dose intravenous imipenem was compared with ceftazidime and the results suggest that the two regimens possess similar efficacy. Cefoperazone-sulbactam has been compared with ceftazidime-trimethoprim-sulphamethoxazole in a small number of patients, and further results are awaited. Relapses of melioidosis should be treated in a similar manner to primary infections.
Chaowagul
W
W
Department of Medicine, Sappasitprasong Hospital, Ubon Ratchathani, Thailand.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016957:Burkholderia pseudomallei / Q000187:drug effects; D002511:Cephalosporins / Q000627:therapeutic use; D006801:Humans; D008554:Melioidosis / Q000188:drug therapy*; D010406:Penicillins / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins