Treatment and prognosis of melioidosis
- Bart Currie, MBBS, FRACP
Bart Currie, MBBS, FRACP
- Infectious Diseases Physician
- Royal Darwin Hospital and Menzies School of Health Research
- Nicholas Anstey, MBBS, FRACP
Nicholas Anstey, MBBS, FRACP
- Infectious Diseases Physician
- Royal Darwin Hospital and Menzies School of Health Research
Melioidosis is a clinically diverse disease caused by the facultative intracellular gram-negative bacterium, Burkholderia pseudomallei [1-3]. This organism is a widely distributed environmental saprophyte in soil and fresh surface water in endemic regions ; the risk of acquiring the infection occurs in these same areas.
The treatment and prognosis of melioidosis will be presented here. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of melioidosis are discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of melioidosis".)
All cases of melioidosis, even mild disease, should be treated with initial intensive therapy (at least two weeks of intravenous therapy) followed by eradication therapy orally for a minimum of three months. B. pseudomallei are characteristically resistant to penicillin, ampicillin, first- and second-generation cephalosporins, gentamicin, tobramycin, and streptomycin [5-7].
Initial intensive therapy — We recommend intensive therapy with one of the following regimens:
●Ceftazidime (50 mg/kg up to 2 g IV every six hours)
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- Initial intensive therapy
- - Ceftazidime
- - Carbapenems
- - Addition of TMP-SMX during initial intensive therapy
- - Alternative agents
- - Duration of intensive therapy
- Adjunctive therapy in the intensive phase
- - Abscess drainage
- - Recombinant G-CSF
- Subsequent eradication therapy
- - Choice of agents
- - Duration
- RISK OF RELAPSE
- SUMMARY AND RECOMMENDATIONS