A comparison of chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline with doxycycline alone as maintenance therapy for melioidosis.

Abstract	A prospective, open, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of the conventional four-drug combination (chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline) with that of doxycycline alone in oral maintenance treatment of melioidosis. Adult Thai patients with culture-confirmed melioidosis were randomized to receive treatment with either regimen for a minimum of 12 weeks, usually following intravenous treatment of severe disease. The main outcome measure was culture-confirmed relapse. One hundred sixteen patients were enrolled; 109 had culture-confirmed melioidosis, and 87 were considered evaluable (43 had received doxycycline). Culture-confirmed relapse occurred in one patient randomized to the conventional regimen and in 11 (25.6%) randomized to the doxycycline regimen (P = .009), and treatment failed for 8 (18.2%) versus 20 (46.5%), respectively (P = .009). Adverse effects occurred in 26% of patients overall. Doxycycline alone cannot be recommended for a first-line regimen of oral maintenance treatment of melioidosis.
Authors	W Chaowagul, A J Simpson, Y Suputtamongkol, M D Smith, B J Angus, N J White
Journal	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 29 Issue 2 Pg. 375-80 (Aug 1999) ISSN: 1058-4838 [Print] United States
PMID	10476745 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References	Anti-Bacterial Agents Anti-Infective Agents Chloramphenicol Trimethoprim, Sulfamethoxazole Drug Combination Doxycycline
Topics	Adolescent Adult Aged Anti-Bacterial Agents (adverse effects, therapeutic use) Anti-Infective Agents (adverse effects, therapeutic use) Chloramphenicol (adverse effects, therapeutic use) Doxycycline (adverse effects, therapeutic use) Drug Therapy, Combination (therapeutic use) Female Humans Male Melioidosis (drug therapy) Microbial Sensitivity Tests Middle Aged Prospective Studies Recurrence Treatment Failure Treatment Outcome Trimethoprim, Sulfamethoxazole Drug Combination (adverse effects, therapeutic use)

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