Oral eradication therapy for melioidosis

Important but not without risks

R. P. Sullivan, L. Ward, B. J. Currie

    Research output: Contribution to journalArticleResearchpeer-review

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    Abstract

    Objectives: The purpose of this study was to quantify the adverse effects from oral eradication therapy for melioidosis, which is usually with high dose trimethoprim-sulfamethoxazole for 3-6 months.


    Methods:
     This retrospective cohort study reviewed side effects from oral eradication therapy in patients presenting with first episode culture-confirmed melioidosis in the tropical north of Australia’s Northern Territory between 1st October 2012 and 1st January 2017.


    Results: 234 patients presented for the first time with culture-confirmed melioidosis. Of these, 16 (6.8%) died during the intensive phase treatment and 6 (2.6%) did not have complete treatment at Royal Darwin Hospital. Of the remaining 212 patients, 203 (95.8%) were initially prescribed trimethoprim-sulfamethoxazole as oral eradication therapy, 6 (2.8%) were prescribed doxycycline and 3 (1.4%) had no eradication therapy. Of the 203 prescribed trimethoprim-sulfamethoxazole, 61 (30.0%) experienced adverse effects, which necessitated a cessation, a change in antibiotic or reduction in dose.


    Conclusions: In patients treated for melioidosis in northern Australia there are high rates of adverse effects from oral trimethoprim-sulfamethoxazole, frequently necessitating a change in therapy or a reduction in dose. Given the side effects and low rates of oral therapy completion in our region we emphasise the importance of the prior often prolonged intensive phase intravenous therapy and using weight based trimethoprim-sulfamethoxazole dosing for eradication therapy.

    Original languageEnglish
    Pages (from-to)111-114
    Number of pages4
    JournalInternational Journal of Infectious Diseases
    Volume80
    DOIs
    Publication statusPublished - Mar 2019

    Fingerprint

    Melioidosis
    Sulfamethoxazole
    Therapeutics
    Northern Territory
    Trimethoprim
    Doxycycline
    Sulfamethoxazole Drug Combination Trimethoprim
    Cohort Studies
    Anti-Bacterial Agents
    Weights and Measures

    Cite this

    @article{b69afbb18c804a29975a1241bc9d35bc,
    title = "Oral eradication therapy for melioidosis: Important but not without risks",
    abstract = "Objectives: The purpose of this study was to quantify the adverse effects from oral eradication therapy for melioidosis, which is usually with high dose trimethoprim-sulfamethoxazole for 3-6 months. Methods: This retrospective cohort study reviewed side effects from oral eradication therapy in patients presenting with first episode culture-confirmed melioidosis in the tropical north of Australia’s Northern Territory between 1st October 2012 and 1st January 2017. Results: 234 patients presented for the first time with culture-confirmed melioidosis. Of these, 16 (6.8{\%}) died during the intensive phase treatment and 6 (2.6{\%}) did not have complete treatment at Royal Darwin Hospital. Of the remaining 212 patients, 203 (95.8{\%}) were initially prescribed trimethoprim-sulfamethoxazole as oral eradication therapy, 6 (2.8{\%}) were prescribed doxycycline and 3 (1.4{\%}) had no eradication therapy. Of the 203 prescribed trimethoprim-sulfamethoxazole, 61 (30.0{\%}) experienced adverse effects, which necessitated a cessation, a change in antibiotic or reduction in dose. Conclusions: In patients treated for melioidosis in northern Australia there are high rates of adverse effects from oral trimethoprim-sulfamethoxazole, frequently necessitating a change in therapy or a reduction in dose. Given the side effects and low rates of oral therapy completion in our region we emphasise the importance of the prior often prolonged intensive phase intravenous therapy and using weight based trimethoprim-sulfamethoxazole dosing for eradication therapy.",
    keywords = "Adverse drug reaction, Burkholderia pseudomallei, Melioidosis, Trimethoprim-sulfamethoxazole",
    author = "Sullivan, {R. P.} and L. Ward and Currie, {B. J.}",
    year = "2019",
    month = "3",
    doi = "10.1016/j.ijid.2019.01.019",
    language = "English",
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    Oral eradication therapy for melioidosis : Important but not without risks. / Sullivan, R. P.; Ward, L.; Currie, B. J.

    In: International Journal of Infectious Diseases, Vol. 80, 03.2019, p. 111-114.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Oral eradication therapy for melioidosis

    T2 - Important but not without risks

    AU - Sullivan, R. P.

    AU - Ward, L.

    AU - Currie, B. J.

    PY - 2019/3

    Y1 - 2019/3

    N2 - Objectives: The purpose of this study was to quantify the adverse effects from oral eradication therapy for melioidosis, which is usually with high dose trimethoprim-sulfamethoxazole for 3-6 months. Methods: This retrospective cohort study reviewed side effects from oral eradication therapy in patients presenting with first episode culture-confirmed melioidosis in the tropical north of Australia’s Northern Territory between 1st October 2012 and 1st January 2017. Results: 234 patients presented for the first time with culture-confirmed melioidosis. Of these, 16 (6.8%) died during the intensive phase treatment and 6 (2.6%) did not have complete treatment at Royal Darwin Hospital. Of the remaining 212 patients, 203 (95.8%) were initially prescribed trimethoprim-sulfamethoxazole as oral eradication therapy, 6 (2.8%) were prescribed doxycycline and 3 (1.4%) had no eradication therapy. Of the 203 prescribed trimethoprim-sulfamethoxazole, 61 (30.0%) experienced adverse effects, which necessitated a cessation, a change in antibiotic or reduction in dose. Conclusions: In patients treated for melioidosis in northern Australia there are high rates of adverse effects from oral trimethoprim-sulfamethoxazole, frequently necessitating a change in therapy or a reduction in dose. Given the side effects and low rates of oral therapy completion in our region we emphasise the importance of the prior often prolonged intensive phase intravenous therapy and using weight based trimethoprim-sulfamethoxazole dosing for eradication therapy.

    AB - Objectives: The purpose of this study was to quantify the adverse effects from oral eradication therapy for melioidosis, which is usually with high dose trimethoprim-sulfamethoxazole for 3-6 months. Methods: This retrospective cohort study reviewed side effects from oral eradication therapy in patients presenting with first episode culture-confirmed melioidosis in the tropical north of Australia’s Northern Territory between 1st October 2012 and 1st January 2017. Results: 234 patients presented for the first time with culture-confirmed melioidosis. Of these, 16 (6.8%) died during the intensive phase treatment and 6 (2.6%) did not have complete treatment at Royal Darwin Hospital. Of the remaining 212 patients, 203 (95.8%) were initially prescribed trimethoprim-sulfamethoxazole as oral eradication therapy, 6 (2.8%) were prescribed doxycycline and 3 (1.4%) had no eradication therapy. Of the 203 prescribed trimethoprim-sulfamethoxazole, 61 (30.0%) experienced adverse effects, which necessitated a cessation, a change in antibiotic or reduction in dose. Conclusions: In patients treated for melioidosis in northern Australia there are high rates of adverse effects from oral trimethoprim-sulfamethoxazole, frequently necessitating a change in therapy or a reduction in dose. Given the side effects and low rates of oral therapy completion in our region we emphasise the importance of the prior often prolonged intensive phase intravenous therapy and using weight based trimethoprim-sulfamethoxazole dosing for eradication therapy.

    KW - Adverse drug reaction

    KW - Burkholderia pseudomallei

    KW - Melioidosis

    KW - Trimethoprim-sulfamethoxazole

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    DO - 10.1016/j.ijid.2019.01.019

    M3 - Article

    VL - 80

    SP - 111

    EP - 114

    JO - International Journal of Infectious Diseases

    JF - International Journal of Infectious Diseases

    SN - 1201-9712

    ER -