Table 1: Minimum Inhibitory Concentrations (Ug/Ml) for Selected Antibiotics
Against Burkholderia pseudomallei and Burkholderia mallei
|
|
Burkholderia pseudomallei |
Burkholderia mallei |
||
|
|
MIC90 |
Range |
MIC90 |
Range |
|
Ampicillin |
32 |
16 - >128 |
64 |
32 - 64 |
|
Amoxycillin- Clavulanic acid |
2 |
0.5 - 4 |
4 |
1 - 4 |
|
Piperacillin |
2 |
0.5-2 |
8 |
1 - 8 |
|
Ticarcillin-Clavulanic acid |
4 |
0.5-16 |
|
|
|
Azlocillin |
4 |
0.5 - 4 |
|
|
|
Cefuroxime |
16 |
8-64 |
64 |
32 - 64 |
|
Cefoperazone-sulbactam |
4 |
1- 16 |
|
|
|
Cefotaxime |
4 |
1-16 |
16 |
4 - 64 |
|
Ceftriaxone |
4 |
1-16 |
32 |
16 -64 |
|
Ceftazidime |
4 |
0.5- 16 |
4 |
1-16 |
|
Cefixime |
2 |
0.5 -4 |
|
|
|
Aztreonam |
16 |
4-32 |
32 |
32 - >64 |
|
Imipenem |
1 |
0.25 -2 |
0.25 |
0.12 -1 |
|
Azithromycin |
|
|
1 |
0.25 -1 |
|
Rifampicin |
32 |
8-64 |
8 |
2 - 16 |
|
Trimethoprim |
64* |
4 - >256* |
16 |
1 - 32 |
|
Sulfamethoxazole |
320 |
40- 2560 |
16 |
0.25 - >64 |
|
Chloramphenicol |
32 |
4- >256 |
32 |
4 - 64 |
|
Doxycycline |
4 |
0.5 - 16 |
0.12 |
<0.03 - 0.5 |
|
Gentamicin |
128 |
8->256 |
0.5 |
0.25 - 1 |
|
Kanamycin |
64 |
8- 256 |
|
|
|
Amikacin |
128 |
16-256 |
2 |
0.5- 4 |
|
Ciprofloxacin |
4 |
1-32 |
1 |
<0.03 - 4 |
|
Ofloxacin |
8 |
1-8 |
8 |
0.5 - 8 |
Table 2: Randomized Treatment Trials in Severe Melioidosis
|
Trial |
Drugs |
No enrolled |
Patients with melioidosis confirmed |
Dose (mg/kg)/ day |
Duration
|
Treatment Failure (%) |
Mortality (%) |
|
White et al 1989
|
Ceftazidime versus Chloramphenicol + Doxycycline + TMP/SMX |
161 |
34 31 |
120 100 4 + 10 + 50 |
> 7 days > 7 days > 7 days |
|
37 74 |
|
Sookpranee et al 1992
|
Ceftazidime + TMP/SMX versus Chloramphenicol + Doxycycline + TMP/SMX |
136 |
27
34 |
100+8+40
100 4 + 8 + 40 |
10-14 days
10-14 day 10-14 day |
|
18.5
47 |
|
Supputamongkol et al 1994 |
Ceftazidime versus Amoxicillin-clavulanate |
379 |
106 106 |
120 160 |
> 7 days > 7 days |
39 51 |
47 47 |
|
Simpson et al 1999 |
Ceftazidime versus Imipenem |
296 |
106 108 |
120 50 |
> 10 days > 10 days |
41 20 |
38 36 |
Table 3: Randomized Trials of Oral Treatment in Melioidosis
|
Trial |
Drugs |
No enrolled |
Dose (mg/kg)/day |
Total duration (weeks) |
Relapse rate (%) |
|
Rajchanuvong et al 1995
|
Amoxicillin-clavulanate versus Chloramphenicol + Doxycycline + TMP/SMX |
49
52 |
60/15
40+ 4 + 10 + 50 |
20
20 |
10
4 |
|
Chaowagul et al 1999 |
Doxycycline versus Chloramphenicol + Doxycycline + TMP/SMX |
58
58 |
4
40+ 4 + 10 + 50 |
20
20 |
26
1 |
|
Chetchotisakd et al 2001 |
Azithromycin + Ciprofloxacin versus Doxycycline + TMP/SMX |
36
29 |
10 + 20
4 + 10 + 50 |
12
20 |
22
3 |
Severe Melioidosis
Ceftazidime 100-120 mg/kg/day in 3 divided doses
Plus
Cotrimoxazole (8-12 and 40-60 mg/kg/day)
Or
ceftazidime plus ciprofloxacin 500 mg x 12 hourly (only two weeks)
Bacteremia Only
Ceftazidime as monotherapy
Or
ceftazidime plus cotrimoxazole or doxycycline 4mg/kg/day
Localized Melioidosis
Amoxicillin clavulanate 160mg/kg/day
Or
Cotrimoxazole plus doxycycline
Oral Maintenance Therapy
Cotrimoxazole plus doxyxyxline initial four weeks with or without chloramphenicol
Or
Amoxicillin clavulanate