Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study

Erdem, Hakan; Ulu-Kilic, Aysegül; Kilic, Selim; Karahocagil, Mustafa; Shehata, Ghaydaa; Eren-Tulek, Necla; Yetkin, Funda; Celen, Mustafa Kemal; Ceran, Nurgul; Gul, Hanefi Cem; Mert, Gurkan; Tekin-Koruk, Suda; Dizbay, Murat; Inal, Ayse Seza; Nayman-Alpat, Saygin; Bosilkovski, Mile; Inan, Dilara; Saltoglu, Nese; Abdel-Baky, Laila; Adeva-Bartolome, Maria Teresa

doi:10.1128/AAC.05974-11

Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study

Journal

Antimicrobial agents and chemotherapy

Date Issued

2012-03

Author(s)

Erdem, Hakan

Ulu-Kilic, Aysegül

Kilic, Selim

Karahocagil, Mustafa

Shehata, Ghaydaa

Eren-Tulek, Necla

Yetkin, Funda

Celen, Mustafa Kemal

Ceran, Nurgul

Gul, Hanefi Cem

Mert, Gurkan

Tekin-Koruk, Suda

Dizbay, Murat

Inal, Ayse Seza

Nayman-Alpat, Saygin

Inan, Dilara

Saltoglu, Nese

Abdel-Baky, Laila

Adeva-Bartolome, Maria Teresa

Ceylan, Bahadir

Sacar, Suzan

Turhan, Vedat

Yilmaz, Emel

Elaldi, Nazif

Kocak-Tufan, Zeliha

Ugurlu, Kenan

Dokuzoguz, Basak

Yilmaz, Hava

Gundes, Sibel

Guner, Rahmet

Ozgunes, Nail

Ulcay, Asim

Unal, Serhat

Dayan, Saim

Gorenek, Levent

Karakas, Ahmet

Tasova, Yesim

Usluer, Gaye

Bayindir, Yasar

Kurtaran, Behice

Sipahi, Oguz Resat

Leblebicioglu, Hakan

DOI

10.1128/AAC.05974-11

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.

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