Methods: A retrospective cohort study was conducted in a Saudi tertiary academic medical center. Eligible patients were adults with confirmed brucellosis (via culture, antibody test, or both) seen between January 2008 and March 2018 who received antibiotic therapy. Endpoints included clinical cure, all-cause mortality, and length of stay (LOS). Data were analyzed using ANOVA and Chi-square. A P value of < 0.05 was considered statistically significant.
Results: Out of 580 patients screened, 79 met the criteria and were included in the study. Based on the most common regimens prescribed, patients were divided into three groups, doxycycline-rifampin-aminoglycoside (DRA) with 39 patients, doxycycline-rifampin (DR) with 28 patients, and other regimens with 12 patients. All groups did not differ in their baseline characteristics except for the location (mostly outpatients or inpatients and very few in the intensive care unit), duration of therapy, and the presence of co-infection (most patients did not have co-infections). The most common risk factor was consumption of raw dairy products and most patients had both B. melitensis and B abortus in their culture and/or antibody test. There was no significant difference between the groups in terms of clinical cure, all-cause mortality, LOS, and end of therapy temperature, white blood cells counts, C-reactive protein levels, and erythrocyte sedimentation rates.
Conclusion: Due to lack of differences in clinical outcomes, all-cause mortality, LOS, and end of therapy parameters between the three groups, a regimen comprising two, rather than three, agents (namely doxycycline and rifampin) can be sufficient. Such finding complies with previous studies although replacing rifampin with an aminoglycoside might be superior per the World Health Organization guidelines for the treatment of brucellosis. Further studies with a larger sample size are warranted to confirm these findings.
S. Alhejaili, None
R. Al-Madfaa, None
K. Eljaaly, None
A. Thabit, None