Oral eradication therapy for melioidosis: Important but not without risks

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

Research output: Contribution to journalArticleResearchpeer-review

5 Downloads (Pure)

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",
volume = "80",
pages = "111--114",
journal = "International Journal of Infectious Diseases",
issn = "1201-9712",
publisher = "BC Decker",

}

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

UR - http://www.scopus.com/inward/record.url?scp=85061367601&partnerID=8YFLogxK

U2 - 10.1016/j.ijid.2019.01.019

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 -