Interventions for treating melioidosis.
BACKGROUND
Melioidosis is an infectious disease caused by a bacterium (Burkholderia pseudomallei) found particularly in some areas in the tropics. It is a serious condition which can be fatal. Beta lactam antibiotics have dramatically reduced the risk of death, but mortality still remains high.


OBJECTIVE
To summarise evidence from randomised trials on the effects of treatment regimens on death and relapse.


METHODS
Cochrane Controlled Trials Register, MEDLINE, EMBASE, BIOSIS from 1966 to September 2000 using MeSH terms "pseudomallei", "melioidosis" together with the terms "randomized-controlled-trial", "random allocation"; reference lists in articles on melioidosis; contact with trialists.


METHODS
Randomised and quasi-randomised trials assessing treatments in patients with melioidosis.


METHODS
Eligibility and trial quality was assessed by two reviewers independently.


RESULTS
For intravenous therapy in the acute phase, we identified five trials with a total of 519 patients. Chloramphenicol, doxycycline, and co-trimoxazole (trimethoprim-sulphamethoxazole) combination regimens were associated with a mortality of 50% or more (two studies). Patients randomised to regimens that included ceftazidime were more likely to survive (relative risk [RR] 0.46, 95% confidence interval [CI] 0.30 to 0.71). When ceftazidime-containing regimens were compared with beta lactam or alternative beta lactamase inhibitor regimens such as co-amoxiclav (amoxycillin-clavulanic acid) and cefoperazone-sulbactam, mortality rates were similar (RR 1.10, 95% CI 0.83 to 1.46), as was the case in one trial of imipenem. For oral therapy in the maintenance phase, we found two trials of 188 participants. Results showed that treatment with the conventional regimen (chloramphenicol, doxycycline, and trimethoprim-sulphamethoxazole) resulted in fewer fatalities in patients compared to a regimen of amoxycillin-clavulanic acid and doxycycline alone.


CONCLUSIONS
Regimens for the acute phase of illness should contain ceftazidime or imipenem. It is not yet clear if combinations of treatments in the early phase reduce relapse. For oral therapy after the acute phase of treatment, trials suggest that conventional four drug regimens can be used for treatment.
Samuel
M
M
Clinical Trials & Epidemiology Research Unit, 10 College Road, Ministry of Health, Singapore, South East Asia, Singapore, 169851 2. miny@cteru.gov.sg
Ti
T Y
TY
D000284:Administration, Oral; D000900:Anti-Bacterial Agents; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008554:Melioidosis / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents