Brucellosis
Brucellosis is a zoonosis that usually presents as a prolonged febrile illness; it is uncommon in Australia. Brucella suis infection can occur in hunters of feral pigs; it has spread from Queensland into New South Wales and possibly the Northern Territory. Brucella abortus or Brucella melitensis infection occurs occasionally in recent migrants and travellers from endemic areas (eg Middle East, southern Europe). Laboratory workers who handle samples from patients with unrecognised brucellosis are also at risk. For postexposure prophylaxis of brucellosis, seek expert advice.
Doxycycline is the mainstay of treatment. Adjunctive gentamicin or rifampicin reduces the rate of treatment failure and relapse.
For adults and children 8 years or older, use:
doxycycline orally, 12-hourly for 6 weeks1 brucellosis doxycycline
adult: 100 mg
child 8 years or older and less than 26 kg: 50 mg
child 8 years or older and 26 to 35 kg: 75 mg
child 8 years or older and more than 35 kg: 100 mg
PLUS
gentamicin 5 mg/kg (child 8 years to younger than 10 years: 7.5 mg/kg up to 320 mg; child 10 years and older: 6 mg/kg up to 560 mg) intravenously, daily for 7 days. Monitor plasma concentration from the first dose—see Principles of aminoglycoside use for dosage adjustment and principles of use2. brucellosis gentamicin
For children 1 month to 8 years, use:
trimethoprim+sulfamethoxazole 5+25 mg/kg orally, 12-hourly for 6 weeks brucellosis trimethoprim + sulfamethoxazole
PLUS
gentamicin 7.5 mg/kg up to 320 mg intravenously, daily for 7 days. Monitor plasma concentration from the first dose—see Principles of aminoglycoside use for dosage adjustment and principles of use3. gentamicin
If gentamicin is contraindicated (see Aminoglycoside contraindications and precautions), replace gentamicin in the above regimens with:
rifampicin 600 mg (child: 15 mg/kg up to 600 mg) orally, daily for 6 weeks. For dosage adjustment in adults with kidney impairment, see rifampicin dosage adjustment. brucellosis rifampicin
Clinical relapse occurs in up to 10% of cases after a 6-week treatment course. Patients with relapsed infection, osteoarticular disease, neurobrucellosis or endocarditis need a longer duration of therapy and may require alternative combination regimens—seek expert advice.