Pediatric Brucellosis Medication

  • Author: Nicholas John Bennett, MB, BCh, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 6, 2010
 

Antibiotics

Class Summary

Despite extensive studies, optimal antibiotic therapy for brucellosis remains under dispute. For acute brucellosis in adults and children older than 8 years, World Health Organization (WHO) guidelines recommend rifampin (600-900 mg) and doxycycline (200 mg) daily for a minimum of 6 weeks. Treatment in children younger than 8 years requires rifampin and cotrimoxazole.[11, 12] Treatment of meningoencephalitis or endocarditis requires combination therapy with rifampin, a tetracycline, and an aminoglycoside.

Table 2. Age-related Dosing of Antimicrobial Agents in Brucellosis (Open Table in a new window)

Age Antimicrobial Agents Dose
Patients >8 yDoxycycline plus streptomycin or doxycycline plus gentamicinDoxycycline: 2-4 mg/kg/d PO qd or divided bid for 6 wk; not to exceed 200 mg/d Streptomycin: 1 g/d IM for 2 wk Gentamicin: 3-5 mg/kg/d IM/IV divided q8h for 1 wk
Alternative in patients >8 yDoxycycline plus rifampinDoxycycline: 2-4 mg/kg/d PO qd or divided bid for 6 wk; not to exceed 200 mg/d Rifampin: 15-20 mg/kg/d PO for 6 wk; not to exceed 600-900 mg/d
Patients < 8 yTrimethoprim-sulfamethoxazole (TMP-SMZ) plus rifampinTMP-SMZ: 8-10 mg (based on TMP component)/kg/d for 45 d; not to exceed 2 double-strength tab/d Rifampin: 15-20 mg/kg/d PO for 45 d; not to exceed 600-900 mg/d
Patients >8 y with meningitis,* endocarditis, or osteomyelitisDoxycycline plus streptomycin or doxycycline plus gentamicinDoxycycline: 2-4 mg/kg/d PO qd or divided bid for 4-6 mo; not to exceed 200 mg/d Streptomycin: 20 mg/kg/d IM for 1-2 wk; not to exceed 1 g/d Gentamicin: 3-5 mg/kg/d IM/IV divided q8h for 1-2 mo
Patients < 8 y with meningitis,* endocarditis, or osteomyelitisTMP-SMZ plus rifampinTMP-SMZ: 8-10 mg (based on TMP component)/kg/d PO divided bid for 4-6 mo Rifampin: 15-20 mg/kg/d PO for 4-6 mo; not to exceed 600-900 mg/d
*The use of corticosteroids as adjunctive therapy to antibiotics may be beneficial in culture-proven meningitis.
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Doxycycline (Bio-Tab, Doxy, Vibramycin)

 

Bacteriostatic agent that reversibly binds to the 30S and 50S bacterial ribosomes.

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Trimethoprim and sulfamethoxazole (Cotrim, Septra, Bactrim)

 

Commonly termed cotrimoxazole. Produces a sequential blockade in folic acid synthesis. This effect is frequently synergistic and bactericidal.

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Rifampin (Rifadin, Rimactane)

 

Bacteriostatic or bacteriocidal agent, depending on concentration of the drug at the site of infection. Suppresses initiation of chain formation for RNA synthesis.

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Streptomycin

 

Bacteriostatic by means of inhibiting protein synthesis by binding to 30S ribosomal subunit.

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Gentamicin (Garamycin)

 

Bacteriostatic by means of inhibiting protein synthesis by binding to 30S ribosomal subunit.

Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. May be administered IV/IM.

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Contributor Information and Disclosures
Author

Nicholas John Bennett, MB, BCh, PhD  Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University

Nicholas John Bennett, MB, BCh, PhD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Walid Abuhammour, MD, FAAP  Professor of Pediatrics, Michigan State University College of Medicine; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center

Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Khaled Nashar, MD  Instructor of Clinical Internal Medicine, Section of Hospitalist Medicine, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center

Khaled Nashar, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Society of Hypertension

Disclosure: Nothing to disclose.

Specialty Editor Board

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

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  2. Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis. Feb 2006;6(2):91-9. [Medline]. [Full Text].

  3. Shakir RA. Neurobrucellosis. Postgrad Med J. Dec 1986;62(734):1077-9. [Medline].

  4. Tena D, Gonzalez-Praetorius A, Lopez-Alonso A, et al. Acute meningitis due to Brucella spp. Eur J Pediatr. May 12 2006;[Medline].

  5. al-Eissa YA, Kambal AM, al-Nasser MN, et al. Childhood brucellosis: a study of 102 cases. Pediatr Infect Dis J. Feb 1990;9(2):74-9. [Medline].

  6. Sharda DC, Lubani M. A study of brucellosis in childhood. Clin Pediatr (Phila). Oct 1986;25(10):492-5. [Medline].

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  8. Ashford DA, di Pietra J, Lingappa J, Woods C, Noll H, Neville B, et al. Adverse events in humans associated with accidental exposure to the livestock brucellosis vaccine RB51. Vaccine. Sep 3 2004;22(25-26):3435-9. [Medline].

  9. Mitka S, Anetakis C, Souliou E, Diza E, Kansouzidou A. Evaluation of different PCR assays for early detection of acute and relapsing brucellosis in humans in comparison with conventional methods. J Clin Microbiol. Apr 2007;45(4):1211-8. [Medline].

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  14. Lubani M, Sharda D, Helin I. Brucella arthritis in children. Infection. Sep-Oct 1986;14(5):233-6. [Medline].

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  17. Committee on Infectious Diseases. Brucellosis. In: Red Book. 27th Ed. 2006:235-237.

  18. Schultze GE, Jacobs RF. Brucella. In: Behrman RE, Kliegman R, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders; 2000:868-9.

  19. Trifiletti RR, Restivo DA, Pavone P, et al. Diabetes insipidus in neurobrucellosis. Clin Neurol Neurosurg. Sep 2000;102(3):163-5. [Medline].

  20. Young EJ. An overview of human brucellosis. Clin Infect Dis. Aug 1995;21(2):283-9; quiz 290. [Medline].

 
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Brucella species are gram-negative in their staining morphology. Brucella species are poorly staining, small gram-negative coccobacilli (0.5-0.7 x 0.6-1.5 µm), and are seen mostly as single cells and appearing like "fine sand."
Table 1. Animal Hosts for Brucella Species
Nomina Species Biovars Preferred Host
B abortus1-6, 9Cattle
B melitensis1-3Goats, sheep
B suis1-3Swine
4Reindeer
5Rodents
B canisNoneDogs[7]
Table 2. Age-related Dosing of Antimicrobial Agents in Brucellosis
Age Antimicrobial Agents Dose
Patients >8 yDoxycycline plus streptomycin or doxycycline plus gentamicinDoxycycline: 2-4 mg/kg/d PO qd or divided bid for 6 wk; not to exceed 200 mg/d Streptomycin: 1 g/d IM for 2 wk Gentamicin: 3-5 mg/kg/d IM/IV divided q8h for 1 wk
Alternative in patients >8 yDoxycycline plus rifampinDoxycycline: 2-4 mg/kg/d PO qd or divided bid for 6 wk; not to exceed 200 mg/d Rifampin: 15-20 mg/kg/d PO for 6 wk; not to exceed 600-900 mg/d
Patients < 8 yTrimethoprim-sulfamethoxazole (TMP-SMZ) plus rifampinTMP-SMZ: 8-10 mg (based on TMP component)/kg/d for 45 d; not to exceed 2 double-strength tab/d Rifampin: 15-20 mg/kg/d PO for 45 d; not to exceed 600-900 mg/d
Patients >8 y with meningitis,* endocarditis, or osteomyelitisDoxycycline plus streptomycin or doxycycline plus gentamicinDoxycycline: 2-4 mg/kg/d PO qd or divided bid for 4-6 mo; not to exceed 200 mg/d Streptomycin: 20 mg/kg/d IM for 1-2 wk; not to exceed 1 g/d Gentamicin: 3-5 mg/kg/d IM/IV divided q8h for 1-2 mo
Patients < 8 y with meningitis,* endocarditis, or osteomyelitisTMP-SMZ plus rifampinTMP-SMZ: 8-10 mg (based on TMP component)/kg/d PO divided bid for 4-6 mo Rifampin: 15-20 mg/kg/d PO for 4-6 mo; not to exceed 600-900 mg/d
*The use of corticosteroids as adjunctive therapy to antibiotics may be beneficial in culture-proven meningitis.
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