Melioidosis: advances in diagnosis and treatment.

PURPOSE OF REVIEW: Melioidosis is an infectious disease caused by the soil-associated Gram-negative bacterium Burkholderia pseudomallei. This review summarizes the evidence underlying current antibiotic regimens and discusses future strategies to reduce mortality.

RECENT FINDINGS: Although simple rapid diagnostics exist, they rely on the availability of direct specimen and are not commercially available. Serological tests and nucleic acid detection are not sufficiently specific or sensitive for routine clinical use. Since the original trials defining setting the standard of care as ceftazidime, no antibiotic regimens have been shown to be superior in comparative trials, but ongoing trials are evaluating the efficacy of meropenem (in intensive treatment) and (TMP-SMX) (for eradication treatment).

SUMMARY: In endemic areas, empiric antibiotics should include agents active against melioidosis as well as the other common causes of severe sepsis. It is likely that future improvements in mortality will be the result of efforts to improve on the early recognition and management of severe sepsis generally.