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

Clin Infect Dis. 1999 Aug;29(2):375-80. doi: 10.1086/520218.

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents / adverse effects
  • Anti-Infective Agents / therapeutic use*
  • Chloramphenicol / adverse effects
  • Chloramphenicol / therapeutic use*
  • Doxycycline / adverse effects
  • Doxycycline / 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
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use*

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Chloramphenicol
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Doxycycline