Treatment

Seek expert advice.

Treatments to consider include:

In adults (1):

• first line regimen : doxycycline 6 weeks+rifampicin 6 weeks+gentamicin 2 weeks OR doxycycline 6 weeks+gentamicin 2 weeks
• alternative : Doxycycline 6 weeks+streptomycin 2 weeks
• second line regimen : Doxycycline+rifampicin 6 weeks OR tetracycline 6 weeks+gentamicin/streptomycin 2 weeks
• not recommended: Monotherapy OR <30 days of treatment OR quinolone with or without rifampicin/doxycycline
  • monotherapy is ineffective and followed by relapse after an initial clinical response

In children:

• children aged under 8 and pregnant women cannot be treated with tetracyclines and quinolones. WHO guidelines recommend rifampicin monotherapy, while other sources recommend co-trimoxazole monotherapy or the combination of these two antibiotics (1)

Note that Brucella are intracellular organisms and relapse is likely, even after antibiotic treatment.

Brucella in milk is killed by pasteurization.

Please check the respective summary of product characteristics of drugs described and the prescribing information in the current issue of BNF.

Reference:

• (1) Shalsky K et al. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2008 Mar 29;336(7646):701-4