Empirical Cephalosporin Treatment of Melioidosis

treated patients, 68.3% of amoxicillin/clavulanic acid–treated paMelioidosis, or infection by Burkholderia pseudomallei, remains tients, and 78.3% of cefotaximeor ceftriaxone-treated patients. a serious cause of mortality and morbidity in northeastern Thailand Among these septicemic patients, the mortality rates were 59.6%, [1]. During the months of the rainy season, B. pseudomallei is the 67.5% (P Å .13), and 81.5% (P õ .001), respectively, and among commonest cause of community-acquired septicemia [1]. Empirical a subgroup of septicemic patients surviving at least 48 hours, the antibiotic regimens for the treatment of presumed communityrates were 47.0%, 47.1%, and 74.4% (P õ .001), respectively. acquired sepsis, such as penicillin/aminoglycoside combinations, have Forty-eight (61%) of 79 cefotaximeor ceftriaxone-treated pano activity against this organism. In areas of endemicity such as this, tients whose therapy was switched to ceftazidime when culture more expensive empirical antibiotic regimens that possess activity results became available died subsequently. Therapy for a further against B. pseudomallei are therefore needed. Amoxicillin/clavulanic 13 patients was switched to amoxicillin/clavulanic acid. acid is widely used and has been shown to be an effective treatment Cefotaxime and ceftriaxone are both marginally less active than of melioidosis [2], although ceftazidime remains the treatment of ceftazidime against B. pseudomallei in vitro [4, 5], and at the choice for severe disease [3]. Other third-generation cephalosporins, doses currently used, these drugs are associated with a significantly particularly cefotaxime and ceftriaxone, are being used increasingly. higher mortality rate among patients with melioidosis. These reThese antibiotics are active in vitro against B. pseudomallei [4, 5] sults suggest that, in areas in which melioidosis is endemic, empiribut have never been formally assessed in controlled treatment trials. cal regimens for treatment of presumed community-acquired septiWe therefore retrospectively reviewed the treatment records of cemia that contain cefotaxime or ceftriaxone are not appropriate. all adult patients with melioidosis (primary presentations only)