title: A randomized, comparative study of dual therapy (doxycycline-rifampin) versus triple therapy (doxycycline-rifampin-levofloxacin) for treating acute/subacute brucellosis.
abstract: OBJECTIVE
  The aim of this study was to compare both the efficacy and safety profile of the WHO-recommended, dual therapy (doxycycline-rifampin) to a quinolone-based, triple therapy (doxycycline-rifampin-levofloxacin) for treating acute/subacute brucellosis.
  
  
  METHODS
  We studied 107 consecutive, naïve patients with acute/subacute brucellosis admitted to Assiut University Hospital. Patients were randomly allocated to receive the dual therapy of doxycycline-rifampin (group-A) or to receive the triple therapy of doxycycline-rifampin-levofloxacin (group-B). Acute/subacute brucellosis was diagnosed based on the presence of: (1) contact with animals or fresh animal products, (2) suggestive clinical manifestations of less than one-year duration, and (3) positive antibody titer (1:160) by standard tube agglutination test.
  
  
  RESULTS
  There was no significant difference between the two groups regarding their demographic data. Fever was the most frequent manifestation (96.3%). Epigastric pain was the most frequent adverse effect of treatment (12.1%). Group-A patients had a significantly higher relapse rate compared to group-B patients (22.6% versus 9.3%, p-value=0.01). The rate of treatment adverse effects was higher among group-B patients, although not reaching statistical significance (20.4% versus 11.3%, p-value=0.059).
  
  
  CONCLUSIONS
  Adding levofloxacin to the dual therapy for acute/subacute brucellosis (doxycycline-rifampin) may increase its efficacy in terms of lowering the relapse rate of the disease. Further, larger scale studies are needed before considering modifying the standard, dual therapy for brucellosis.
authors.affiliation: Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt. Electronic address: a.fh@outlook.com.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hasanain
authors.affiliation: Department of Internal Medicine-Gastroenterology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Reem
authors.initials: R
authors.lastname: Mahdy
authors.affiliation: Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Mohamed
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Ali
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002006:Brucellosis / Q000188:drug therapy*; D004318:Doxycycline / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D064704:Levofloxacin / Q000008:administration & dosage*; D008297:Male; D012293:Rifampin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D004318:Doxycycline; D012293:Rifampin
keywords: Brucellosis; Doxycycline; Levofloxacin; Rifampin