I had four cases of Brucellosis during 3 months ago with complication (lumbar bone was involved ). I treated them with STM+DX+RIF and the response was slow. In Iran Brucella Melitensis is common and we had not drug resistance against this infection. I want to know what is your recommendations for this complication?
Brucellosis of bone especially spondodiscitis, sacroiletis or paraspinal collection is well known manifestations of this infection. We had few such cases in past year as kashmir has similar infection profile as iran. In one such patient we added ceftrixone to achieve quicker defervesence and it worked.
Dear Ahmet;
Thank you
Would you please send me the full paper .I could not get it via web site.My email is [email protected]
Best
Batool
The response for brucellar spondylodiscitis is in general slow. So you need at least 6 months of treatment in order to see if you have responce or not.
When you say slow responce what do you mean?? and how you define it?
Clinicaly or according to MRI findings.
Nevertheless if you have evidence of no responce you can choose either to use an alternative combination (add ciprofloxacin 500mgx2 instead of STM and increase the dose of RIF from 600 to 900 mg, if not already given at that dose) or concider surgical therapy (Debridement, Diskektomy or drainage of abscesses)
I think that you will also find usefull the following paper
http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2010.03272.x/pdf
Regards
AT
Management of brucellosis involving the spine has not been standardized and drug selection, duration of antibiotics, and the role of surgery still remain controversial. Various dual or triple antibiotic regimens including different antimicrobials such as doxycycline, tetracycline, rifampicin, ciprofloxacin, ofloxacine, trimethprim sulfamethoxazole, and aminoglycoside have been suggested for spinal brucellosis. The duration of antibiotic therapy for brucellar spondylitis is longer than systemic brucellosis without spondylitis, commonly a period between 6 and 12 weeks. Bayindir et al., 2003 reported that there was a maximum good response and no relapse in the combination group of aminoglycoside (streptomycin 1g/day for 15 days), doxycycline (200 mg/day for 45 days), and rifampicin (15 mg/kg/day for 45 days). Because brucellosis usually responds to antibiotics, surgery is considered as the last resort in treating spinal brucellosis, but severe neurologic deficit and incapacitating pain often necessitate surgical intervention. In case,where there is no neurologic deficit and back pain was controlled by bed rest and analgesics; therefore antimicrobial thearpy was preferentially considered over surgical decompression.
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