Open AccessEfficacy and Tolerability of Antibiotic Combinations in Neurobrucellosis: Results of the Istanbul Study
Author(s) -
Hakan Erdem,
Ayşegül Ulu-Kılıç,
Selim Kılıç,
Mustafa Kasım Karahocagil,
Ghaydaa A. Shehata,
Necla Tülek,
Funda Yetkin,
Mustafa Kemal Çelen,
Nurgül Ceran,
Hanefi Cem Gül,
Gürkan Mert,
Suda Tekin-Koruk,
Murat Dizbay,
Ayşe Seza İnal,
Saygın Nayman-Alpat,
Mile Bosilkovski,
Dilara İnan,
Neşe Saltoğlu,
Laila Abdel-Baky,
Maria Teresa Adeva-Bartolome,
Bahadır Ceylan,
Suzan Saçar,
Vedat Turhan,
Emel Yılmaz,
Nazif Elaldı,
Zeliha Kocak-Tufan,
Kenan Uğurlu,
Başak Dokuzoğuz,
Hava Yılmaz,
Sibel Gündeş,
Rahmet Güner,
Nail Özgüneş,
Asım Ülçay,
Serhat Ünal,
Saim Dayan,
Levent Görenek,
Ahmet Karakaş,
Yeşim Taşova,
Gaye Usluer,
Yaşar Bayındır,
Behice Kurtaran,
Oğuz Reşat Sıpahi,
Hakan Leblebicioğlu
Publication year - 2012
Publication title -
antimicrobial agents and chemotherapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.07
H-Index - 259
eISSN - 1070-6283
pISSN - 0066-4804
DOI - 10.1128/aac.05974-11
Subject(s) - ceftriaxone , medicine , tolerability , regimen , antibiotics , doxycycline , cephalosporin , surgery , adverse effect , microbiology and biotechnology , biology
No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versusn = 6/42 [14.3%];P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%,n = 6/42) compared to P1 (2.6%,n = 3/117) and P3 (6.1%,n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.