Brucellosis treatment

A variety of other clinically important infections, such as brucellosis, listeriosis, salmonellosis, and various Mycobacterium infections, are of interest as these are often localized in organs rich in MPS cells. Liposome encapsulation has been demonstrated to improve therapeutic indices of several drugs in a number of infectious models. The natural avidity of macrophages for liposomes can also be exploited in the application of the vesicles as carriers of immunomodulators to activate these cells to an microbicidal, antiviral, or tumoricidal state. These studies were recently reviewed by Emmen and Storm (1987), Popescu et al. (1987), and Alving (1988). In addition to the treatment of "old" infectious diseases, the concept of MPS-directed drug delivery is of considerable interest for the therapy AIDS, possibly enabling control of human immunodeficiency virus replication in human macrophages. 

Jarisch-Herxheimer reaction following treatment of syphilis, brucellosis, schistosomiasis, or trypanosomiasis... 

The recommended treatment is doxycycline (200 mg/day) plus rifampin (600 mg/day) for six weeks. An alternative effective treatment is six weeks of doxycycline (200 mg/day) plus streptomycin (1 gm/day) for three weeks. Trimethoprim-sulfamethoxazole given four to six weeks is less effective. In 5 to f 0 percent of cases, there may be a relapse or treatment failure. Regarding prophylaxis, killed and live attenuated human vaccines are available in many countries but are considered of unproven efficacy. There tends to be no information on the use of antibiotics for prophylaxis against human brucellosis. 

Doxycyline is a tetracycline antibiotic. All tetracylines are bacteriostatic, have a broad spectrum and are the treatment of choice for infections caused by Chlamydia and Rickettsia and in brucellosis. Doxycyline and minocyline are the only two tetracyclines that may be administered in renal impairment. 

Tetracyclines remain the agents of choice in rickettsial infections, and are also used in chlamydial, vibrio, mycoplasmal and spirochaetal infections, brucellosis and the management of chronic bronchitis and acne. They are used in combination with other agents in the treatment of malaria and amoe-biasis, and doxycycline is used for prophylaxis of malaria. 

Gonorrhea, typhoid fever, and brucellosis have been treated with TMP-SMX with cure rates comparable to those attained by standard therapy. It also has been used in the treatment of nocardial infections. 

Respiratory, skin, and soft-tissue infections UTIs pelvic inflammatory disease (PID) brucellosis trachoma Rocky Mountain spotted fever typhus Q fever lickettsia severe acne (Adoxa) smallpox psittacosis ornithosis granuloma inguinale lymphogranuloma venereum intestinal amebiasis (adjunctive treatment) prevention of rheumatic fever ... 

It is used in all forms of tuberculosis along with other antitubercular drugs. Other indications are tularemia, plague, brucellosis, bacterial endocarditis, entero-coccal endocarditis. Used concomitantly with penicillin G for synergistic effect in the treatment of enterococcal endocarditis when other antibiotics are ineffective or contraindicated. 

Apart from its main use in tuberculosis, it is also used in leprosy and prophylaxis of meningitis due to H. influenzae and meningococci. It is also used with doxycycline in treatment of brucellosis. 

Although the clinical usefulness of tetracyclines is limited for most of the common microbial pathogens, they remain drugs of choice (or very effective alternative therapy) for a wide variety of infections caused by less common pathogens. These include brucellosis rickettsial infections such as Rocky Mountain spotted fever, typhus, and Q fever Mycoplasma pneumonia cholera plague Ureaplasma urethritis Chlamydia infections and Lyme disease. Oral doxycycline, 100 mg orally twice a day for 7 days, is a recommended treatment for chlamydial sexually transmitted disease. 

Another point that has defied explanation is this SM is bacteriocidal only during periods of high rates of protein synthesis. Thus other protein inhibitors such as tetracyclines or chloramphenicol should interfere with its action, yet this theoretical drug interaction is not necessarily clinically contraindicated. In fact, a combination of streptomycin and tetracycline is the treatment of choice for glanders and brucellosis. 

Tetracyclines are effective in the treatment of Rocky Mountain spotted fever, murine typhus, recrudescent epidemic typhus, scrub typhus, Q fever, lymphogranuloma venereum, psittacosis, tularemia, brucellosis, gonorrhea, certain urinary tract infections, granuloma inguinale, chancroid, syphilis, and disease due to Bacteroides and Clostridium. 

Rare indications for furazolidone include its use for the treatment of brucellosis . The cure rate, however, was low (50 per cent) whereas those of chloramphenicol plus streptomycin as well as oxytetracycline plus streptomycin was 85 and 88 per cent respectively. Osha reported good results in the treatment of trichomonal infections in women. A mixture of furazolidone plus nifuroxime plus stilbesterol was used later for this indication under the trade name of Tricofuron. A somewhat different combination also containing furazolidone and diethylstilbesterol was administered in another group of 40 patients for a period of five to eight days. No relapses had occurred after 6 months. 

Colmenero, J.D. Ferndndez-Gallardo, L.C. Agundez, J.A.G. Sedeno, J. Benitez, J. Valverde, E. Possible implications of doxycycline-rifampin interaction for treatment of brucellosis. Antimicrob.Agents Chemother., 1994, 38, 2798-2802 [extracted rifampin plasma serum papaverine (IS) LOQ 200 n mL]... 

Nocardia infections have been treated successjully, but failures also have been reported. Although a combination of doxycycline and streptomycin or gentamicin is considered the treatment of choice for brucellosis, trimethoprim—sulfamethoxazole may be an effective substitute for the doxy-cyctine combination. Trimethoprim—sulfamethoxazole also has been used successjully for Whipple s disease, Stenotrophomonas maltophilia infection, and infection by the intestinal parasites Cyclospora and Isospora. 

Streptomycin has no useful activity in the treatment of (A) Bubonic plague Brucellosis Lyme disease Tuberculosis Tularemia... 

Streptomycin is the drug of choice for treatment of plague and tularemia and has important adjunctive value in tuberculosis. Gentamicin (plus tetracycline) is usually preferred in brucellosis, but streptomycin is a backup drug. Aminoglycosides have minimal activity in Lyme disease, which is usually treated with either doxycycUne or amoxicillin. The answer is (C). 

Streptomycin and dihydrostreptomycin are used only in special cases, e.g. in combination with isoniazid for the treatment of tuberculosis or in combination with tetracycline in the case of brucellosis... 

Luzzi GA, Brindle R, Sockett PN, Solera J, Klenerman P, Warrell DA. Brucellosis Imported and laboratory-acquired cases, and an overview of treatment trials. Trans R Soc Trop Med Hyg. 1993 87(2) 138-141. 

Ariza J, Gudiol F, Pallares R, et al. Treatment of human brucellosis with doxycycline plus rifampin or doxycycline plus streptomycin A randomized, double-blind study. Ann Intern Med. 1992 117(1) 25-30. 

Montejo JM, Alberola I, Glez ZP, et al. Open, randomized therapeutic trial of six antimicrobial regimens in the treatment of human brucellosis. Clin Infect Dis. 1993 16(5) 671—676. 

Five patients with brucellosis taking doxyeyeline 200 mg daily had a reduction in the doxycycline half-life from 14.52 to 7.99 hours when they took rifampicin 200 mg daily Another study of 20 patients treated for brucellosis found that the mean AUC of doxyeyeline was nearly 60% lower in the presence of rifampicin as opposed to streptomyein. There were no treatment failures in the patients taking doxycycline and streptomyein, but 2 treatment failures occurred in the 10 patients taking doxyeyeline and rifampicin. ... 

All of the current R D on brucellosis located by the committee focuses on development of a vaccine. As noted above, the committee considers it unlikely that a vaccine could be usefully employed for protection from a domestic terrorist attack and therefore considers such R D a low priority for improving civilian medical capability. Antibiotic treatment, though not simple, is possible with current products. USAMRIK) conducts assays of second-and third-generation antibiotics as they come on the market, using all of the bacterial threat agents in animal models. 

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