CBRNE - Glanders and Melioidosis Medication

Updated: Jan 25, 2022
  • Author: Paul P Rega, MD, FACEP; Chief Editor: Duane C Caneva, MD, MSc  more...
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Medication Summary

Limited information exists about antibiotic therapy for glanders and melioidosis because clinical studies examining antibiotic effectiveness in humans are rare. In general, these diseases show poor responsiveness to traditional antimicrobial regimens and require prolonged therapy. [2, 4, 5]

Because human glanders is so infrequent, efficacious antibiotic therapy is largely limited. No treatment regimen is approved by the US Food and Drug Administration, but anecdotal regimens have included imipenem, meropenem, and ceftazidime, with or without trimethoprim/sulfamethoxazole. [2]



Class Summary

Base choice of antibiotic and route of administration on the clinical setting.

Meropenem (Merrem IV)

Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis. Effective against most gram-positive and gram-negative bacteria.

Has slightly increased activity against gram-negative organisms and slightly decreased activity against staphylococci and streptococci compared with imipenem.

Imipenem and cilastatin (Primaxin)

For treatment of multiple organism infections in which other agents do not have wide spectrum coverage or are contraindicated due to potential for toxicity.

Ceftazidime (Fortaz)

Bactericidal, exerting effect by inhibition of enzymes responsible for cell wall synthesis.

Tetracycline (Minocin)

Primarily bacteriostatic and believed to exert antimicrobial effect by inhibition of protein synthesis.

Sulfamethoxazole and trimethoprim (Bactrim, Bactrim DS, Septra, Septra DS)

SMX inhibits bacterial synthesis of dihydrofolic acid by competing with PABA. TMP blocks production of tetrahydrofolic acid from dihydrofolic acid by binding to and reversibly inhibiting the required enzyme, dihydrofolate reductase; thus, it blocks 2 consecutive steps in biosynthesis of nucleic acids and proteins essential to many bacteria.

Amoxicillin and clavulanate (Augmentin)

Semisynthetic antibiotic with a broad spectrum of bactericidal activity against many gram-positive and gram-negative microorganisms. Susceptible to degradation by beta-lactamases, and, thus, spectrum of activity does not include organisms that produce these enzymes. Clavulanic acid is a beta-lactam, structurally related to penicillins, which possesses ability to inactivate a wide range of beta-lactamase enzymes commonly found in microorganisms resistant to penicillins and cephalosporins. Formulation of amoxicillin and clavulanic acid protects amoxicillin from degradation by beta-lactamase enzymes and effectively extends antibiotic spectrum of amoxicillin to include many bacteria normally resistant to amoxicillin and other beta-lactam antibiotics. Possesses properties of a broad-spectrum antibiotic and a beta-lactamase inhibitor.


Aminoglycoside antibiotic recommended when less potentially hazardous therapeutic agents are ineffective or contraindicated.