Abstract
Background: International melioidosis treatment
guidelines recommend a minimum 10 to 14 days’ intravenous antibiotic
therapy (intensive phase), followed by 3 to 6 months’ oral therapy
(eradication phase). This approach is associated with rates of relapse,
defined as recurrence following the eradication phase, that can exceed
5%. Rates of recrudescence, defined as recurrence during the eradication
phase, have not previously been reported. In response to low
eradication phase completion rates in Australia, a local guideline has
evolved over the last ten years recommending a longer minimum intensive
phase duration for many cases of melioidosis.
Methodology/ Principal Findings: This
retrospective cohort study reviews antibiotic duration for the first
episode of care for all patients diagnosed with melioidosis and
surviving the intensive phase during a recent three year period in the
tropical north of Australia’s Northern Territory; we also review
adherence to the current local guideline and treatment outcomes. Of 215
first episodes of melioidosis surviving the intensive phase, the median
(interquartile range) intensive phase duration was 26 (14-34) days. One
hundred and eight (50.2%) patients completed eradication therapy; 58
(27.0%) patients took no eradication therapy. At 28 months’ follow-up,
one (0.5%) relapse and eleven (5.1%) recrudescences had occurred. On
exact logistic regression analysis, the only independent risk factors
for recrudescence were self-discharge during the intensive phase (odds
ratio 6.2 [95% confidence interval 1.2-30.0]) and septic shock (odds
ratio 5.3 [95% confidence interval 1.1-25.7]).
Conclusions/ Significance: Relapsed
melioidosis is rare in patients who receive a minimum intensive phase
duration specified by our guideline and extended according to clinical
progress. Recrudescence rates may improve with reductions in rates of
self-discharge. Given the low relapse rate despite a high rate of
eradication therapy non-adherence, the duration and necessity of
eradication therapy for different patients after guideline-concordant
intensive therapy should be evaluated further.
Original language | English |
---|---|
Article number | e0003586 |
Pages (from-to) | 1-16 |
Number of pages | 16 |
Journal | PLoS Neglected Tropical Diseases |
Volume | 9 |
Issue number | 3 |
DOIs | |
Publication status | Published - 26 Mar 2015 |