Open forum infectious diseases · 2026
Omitting the Eradication Phase of Treatment of Adults with Melioidosis: A Pilot, Single-Center Randomized Controlled Trial.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Smith Simon, Stewart James, Binotto Enzo, Ho Jennifer, Yarwood Trent, Nancarrow Valerie, Harris Julian, Wood John, Ragh Thomas, Reilly Christopher, Shiel Emily, Catchpoole Elizabeth, Hanson Josh
Аннотация
BACKGROUND: Contemporary Australian guidelines for the management of melioidosis recommend a longer duration of intravenous antibiotics during the intensive phase of treatment; recurrent disease is now far less common. A high rate of adverse drug reactions (ADRs) to the currently recommended minimum of 3 months of oral trimethoprim/sulfamethoxazole (TMP/SMX) eradication therapy questions the incremental value of this phase of treatment.
METHODS: In this pilot, single-center, open-label randomized controlled trial, adults with culture-confirmed melioidosis received either prolonged intravenous intensive-phase therapy followed by oral eradication-phase therapy with TMP/SMX (standard therapy) or prolonged intravenous intensive-phase therapy alone (short-course therapy). The primary outcome was culture-confirmed recurrence at 2 years. Secondary outcomes included clinical (culture-unconfirmed) recurrence and ADRs to TMP/SMX.
RESULTS: Among 33 participants, 5 had culture-confirmed recurrence: 0/16 in the standard therapy group and 5/17 (29%) in the short-course therapy group. One participant (6%) in the standard therapy group had clinical recurrence. An ADR to TMP/SMX occurred in 13/16 (81%) in the standard therapy group, necessitating TMP/SMX cessation in 7/13 (44%), hospitalization in 5/13 (38%), and intensive care unit admission in 1/13 (8%).
CONCLUSIONS: Prolonged intravenous antibiotics alone will cure many patients with melioidosis; however, some still require oral eradication therapy. The potential for recurrence of life-threatening melioidosis must be balanced against the high rate of significant ADRs to high-dose TMP/SMX. This necessitates a greater understanding of the individuals at highest risk of recurrence and determination of the optimal dosing and duration of eradication therapy in those who need it.
METHODS: In this pilot, single-center, open-label randomized controlled trial, adults with culture-confirmed melioidosis received either prolonged intravenous intensive-phase therapy followed by oral eradication-phase therapy with TMP/SMX (standard therapy) or prolonged intravenous intensive-phase therapy alone (short-course therapy). The primary outcome was culture-confirmed recurrence at 2 years. Secondary outcomes included clinical (culture-unconfirmed) recurrence and ADRs to TMP/SMX.
RESULTS: Among 33 participants, 5 had culture-confirmed recurrence: 0/16 in the standard therapy group and 5/17 (29%) in the short-course therapy group. One participant (6%) in the standard therapy group had clinical recurrence. An ADR to TMP/SMX occurred in 13/16 (81%) in the standard therapy group, necessitating TMP/SMX cessation in 7/13 (44%), hospitalization in 5/13 (38%), and intensive care unit admission in 1/13 (8%).
CONCLUSIONS: Prolonged intravenous antibiotics alone will cure many patients with melioidosis; however, some still require oral eradication therapy. The potential for recurrence of life-threatening melioidosis must be balanced against the high rate of significant ADRs to high-dose TMP/SMX. This necessitates a greater understanding of the individuals at highest risk of recurrence and determination of the optimal dosing and duration of eradication therapy in those who need it.