Brucellosis: Drug Therapy

Therapeutic targets

  • Elimination of the pathogens
  • Avoidance of complications

Therapy recommendations

  • First-line therapy: antibiotic therapy, i.e., combination of doxycycline + aminoglycoside (e.g., streptomycin; see below); according to a Cochrane analysis, this combination is better than the 6-week administration of doxycycline + rifampicin
  • Alternatively, other aminoglycosides: e.g., gentamycin (5 mg/kg bw/day i.m. or i.v. for 10-14 days) + doxycycline (2 times 100 mg/day for 45 days)
  • Second-line therapy: antibiotic therapy with quinolones + rifampicin.
  • Due to high relapse rates (recurrence of the disease), monotherapies are contraindicated (“not allowed”).
  • The duration of therapy should be 4 to 6 weeks.
  • Therapy of a pregnant woman:
    • No tetracyclines, streptomycin (aminoglycoside) and quinolones!
    • Monotherapy with rifampicin or cotrimoxazole or combination therapy with both.
  • If necessary, symptomatic therapy (antiemetics/anti-nausea and anti-nausea drugs).
  • In case of endocarditis (inflammation of the heart lining), long-term antibiotic therapy in combination with surgical valve replacement.
  • See also under “Further therapy”.