Treatment of neurobrucellosis: what is known and what remains to be answered.
Neurological involvement is one of the most perplexing and diverse presentation complications of brucellosis, a worldwide prevalent zoonosis. This review presents the current knowledge available from medical literature and discusses the shortcomings of the existing data. A proposed regimen should include doxycycline and rifampicin and, with the benefit of doubt, ceftriaxone, since its high concentration in the cerebrospinal fluid may offer significant efficacy against the pathogen. Corticosteroids have been used in specialized situations. The use of streptomycin is discouraged owing to its questionable ability to penetrate into the cerebrospinal fluid and its potential neurotoxicity that may perplex the clinical presentation. Treatment duration should be individualized in the absence of an adequate cut-off index.
Pappas
Georgios
G
Institute of Continuing Medical Education of Ioannina, H, Trikoupi 10, Ioannina 45333, Greece. gpele@otenet.gr
Akritidis
Nikolaos
N
Christou
Leonidas
L
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002006:Brucellosis / Q000150:complications / Q000188:drug therapy*; D002443:Ceftriaxone / Q000627:therapeutic use; D020806:Central Nervous System Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D004318:Doxycycline / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D012293:Rifampin / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D004318:Doxycycline; D012293:Rifampin; D013307:Streptomycin