Year: 2012
Type: Article
Title: Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study
Author: Erdem, Hakan
Author: Ulu-Kilic, Aysegül
Author: Kilic, Selim
Author: Karahocagil, Mustafa
Author: Shehata, Ghaydaa
Author: Eren-Tulek, Necla
Author: Yetkin, Funda
Author: Celen, Mustafa Kemal
Author: Ceran, Nurgul
Author: Gul, Hanefi Cem
Author: Mert, Gurkan
Author: Tekin-Koruk, Suda
Author: Dizbay, Murat
Author: Inal, Ayse Seza
Author: Nayman-Alpat, Saygin
Author: Bosilkovski, Mile
Author: Inan, Dilara
Author: Saltoglu, Nese
Author: Abdel-Baky, Laila
Author: Adeva-Bartolome, Maria Teresa
Author: Ceylan, Bahadir
Author: Sacar, Suzan
Author: Turhan, Vedat
Author: Yilmaz, Emel
Author: Elaldi, Nazif
Author: Kocak-Tufan, Zeliha
Author: Ugurlu, Kenan
Author: Dokuzoguz, Basak
Author: Yilmaz, Hava
Author: Gundes, Sibel
Author: Guner, Rahmet
Author: Ozgunes, Nail
Author: Ulcay, Asim
Author: Unal, Serhat
Author: Dayan, Saim
Author: Gorenek, Levent
Author: Karakas, Ahmet
Author: Tasova, Yesim
Author: Usluer, Gaye
Author: Bayindir, Yasar
Author: Kurtaran, Behice
Author: Sipahi, Oguz Resat
Author: Leblebicioglu, Hakan
Abstract: No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.
Publisher:
Relation: Antimicrobial agents and chemotherapy
Identifier: oai:repository.ukim.mk:20.500.12188/24619
Identifier: http://hdl.handle.net/20.500.12188/24619Identifier: 10.1128/AAC.05974-11
Identifier: 56
Identifier: 3
