Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis [ISRCTN31053647]

Background

The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis.

Methods

The patients diagnosed as spinal brucellosis between January 2002 to December 2004 were enrolled into the study. Patients were enrolled into the two antimicrobial therapy groups (doxycycline plus streptomycin vs. ciprofloxacin plus rifampicin) consecutively. For the cost analysis of the two regimens, only the cost of antibiotic therapy was analysed for each patient.

Results

During the study period, 31 patients with spinal brucellosis were enrolled into the two antimicrobial therapy groups. Fifteen patients were included in doxycycline plus streptomycin group and 16 patients were included in ciprofloxacin plus rifampicin group. Forty-two levels of spinal column were involved in 31 patients. The most common affected site was lumbar spine (n = 32, 76%) and involvement level was not different in two groups. Despite the disadvantages (older age, more prevalent operation and abscess formation before the therapy) of the patients in the ciprofloxacin plus rifampicin group, the duration of the therapy (median 12 weeks in both groups) and clinical response were not different from the doxycycline plus streptomycin. The cost of ciprofloxacin plus rifampicin therapy was 1.2 fold higher than the cost of doxycycline plus streptomycin therapy.

Conclusion

Classical regimen (doxycycline plus streptomycin), with the appropriate duration (at least 12 weeks), is still the first line antibiotics and alternative therapies should be considered when adverse drug reactions were observed.

[Comparative study on efficacy of regimens including streptomycin or ethambutol]

OBJECTIVE

To evaluate the advantages and disadvantages of regimens of 2E3H3R3Z3/4H3R3(EMB regimen) and 2S3H3R3Z3/4H3R3(SM regimen) in tuberculosis control program.

METHOD

Retrospective, cross-sectional and prospective studies were carried out in Shijiazhuang city, Hebei province from January 1994 to June 1996.

RESULT

There was no significant difference between the two regimens in efficacy, relapse rate and full course supervision. The EMB regimen was found more applicable than the SM regimen, and the SM regimen caused more side effects than the EMB regimen. Streptomycin skin test had a 4.5% positive rate, and using SM costs 84% more than using EMB. One of the drawbacks found in the SM regimen was that only in 42.9% of the rural sanitation units the disinfection standard could be fulfilled, and the patients preferred the EMB regimen to the SM regimen.

CONCLUSION

The EMB regimen is more applicable than the SM regimen in the tuberculosis control program.

Control of Brucella melitensis infection in a large camel herd in Saudi Arabia using antibiotherapy and vaccination with Rev. 1 vaccine

The authors describe an attempt to control Brucella melitensis infection in a large camel herd in Saudi Arabia. Sera from the entire herd (2,536) were examined by the Rose Bengal and standard United States of America buffered plate agglutination tests. The overall Brucella seroprevalence was 8%. Milk samples from the 120 seropositive milking camels were cultured on Brucella-selective media. B. melitensis biovars 1, 2 and 3 were isolated from 41 camels (34%). Seropositive camels (202) were treated for the first time with a combination of long-acting oxytetracycline (OTC) at a dose of 25 mg/kg administered intramuscularly (i.m.) every 2 days for 30 days and streptomycin at 25 mg/kg i.m. every 2 days for 16 days. In addition, milking camels were given OTC-intramammary infusion at a rate of 10 ml/teat every 2 days for 8 days. This regimen was found to be effective in eliminating the shedding of Brucella organisms by camels, with no relapse. Moreover, all treated camels became seronegative within 16 months after treatment. Seronegative camels (2,331) were vaccinated for the first time with the B. melitensis Rev. 1 strain vaccine, as follows: a) 175 young camels (aged three months to one year) were each inoculated subcutaneously with a full dose (1-2 x 10(9) viable organisms in 1 ml). Brucella antibody titres between 1:50 and 1:200 were detected 2-4 weeks post-vaccination. Brucella antibodies decreased gradually until the animals became seronegative 8 months after vaccination. b) 2,156 camels aged more than one year were each inoculated subcutaneously with a reduced dose (1-2 x 10(6) viable organisms in 1 ml). Antibody titres measured 2-4 weeks post-vaccination varied from 1:25 to 1:200. The titres decreased gradually, until the animals became seronegative 3 months post-vaccination. No Brucella organisms were recovered from repeated udder secretion samples from all vaccinated milking camels, and no abortions were recorded among pregnant vaccinated camels.