A randomized, comparative study of dual therapy (doxycycline-rifampin) versus triple therapy (doxycycline-rifampin-levofloxacin) for treating acute/subacute brucellosis

Abstract Aim The aim of this study was to compare both the efficacy and safety profile of the WHO-recommended, dual therapy (doxycycline–rifampin) to a quinolone-based, triple therapy (doxycycline–rifampin–levofloxacin) for treating acute/subacute brucellosis. Patients and methods We studied 107 consecutive, naïve patients with acute/subacute brucellosis admitted to Assiut University Hospital. Patients were randomly allocated to receive the dual therapy of doxycycline–rifampin (group-A) or to receive the triple therapy of doxycycline–rifampin–levofloxacin (group-B). Acute/subacute brucellosis was diagnosed based on the presence of: (1) contact with animals or fresh animal products, (2) suggestive clinical manifestations of less than one-year duration, and (3) positive antibody titer (1:160) by standard tube agglutination test. Results There was no significant difference between the two groups regarding their demographic data. Fever was the most frequent manifestation (96.3%). Epigastric pain was the most frequent adverse effect of treatment (12.1%). Group-A patients had a significantly higher relapse rate compared to group-B patients (22.6% versus 9.3%, p-value = 0.01). The rate of treatment adverse effects was higher among group-B patients, although not reaching statistical significance (20.4% versus 11.3%, p-value = 0.059). Conclusions Adding levofloxacin to the dual therapy for acute/subacute brucellosis (doxycycline–rifampin) may increase its efficacy in terms of lowering the relapse rate of the disease. Further, larger scale studies are needed before considering modifying the standard, dual therapy for brucellosis.

Laparoscopic versus open cholecystecystectomy for acute calculous cholecystitis; which is better?

Laparoscopic cholecystectomy [LC] has become the treatment of choice for elective cholecystectomy, but controversy persists over use of this approach in the treatment of acute calculous cholecystitis. To assess the feasibility, safety, and outcome of laparoscopy in management of patients with acute calculous cholecystitis and to determine whether it is a boon or bust in comparison with open cholecystectomy [OC]. This study included 84 patients [38 males and 46 females] who met criteria for acute calculous cholecystitis. Their age ranged from 19 to 65 year with average of 47 years. They were randomized to be treated by LC [40 patients] or OC [44 patients]. Operation time, postoperative pain, length of hospital stay, intraoperative and postoperative complications were the main outcome measures used to compare the two studied groups. In LC group, the rate and reasons for conversion to OC were also studied. The two randomized groups were similar in demographic, physical, and clinical characteristics. There was no significant difference in the operation time between LC and OC [89.9 min +/- 19.9 vs.83.9 min- +/- 8.2, P: 0.2]. Postoperative analgesia was better in the LC than in the OC with median score [VAS] of 2 points vs.4 points in the two groups respectively and the mean analgesic requirements was 160mg +/- 40 vs.240mg +/- 60 in the two groups respectively [P: 0.0004]. The length of hospital stay for patients who underwent successful LC was significantly shorter than the open group [2.2 days +/- 0.82 vs.6.4 daysfl. +/- 1.6, P: 0.0001]. Operative complications were higher in the LC group than in the OC group. By far the commonest was gallbladder perforation with spillage of bile and or stones [25%]. Bleeding occurred in five patients in the LC group [12.5%] and in two patients in the OC group [4.5%]. There were no deaths or bile duct injuries in either group. Postoperative complications were higher in the OCR than in the LC. By far the commonest were wound related complications [11.4%]. Wound sepsis occurred in five cases in OC group [11.4%] and in two cases in LC group [7.7°%]. Incisional hernia and intestinal obstruction each occurred in one case in the OC [2.3%]. In LC group, 14 patients required conversion to OC [35%], in 10 of them [71%] the cause was obscure anatomy and dense adhesions of inflammation. Male gender represents the majority of converted cases [64%]. LC is feasible and safe method for treatment of patients with acute calculous cholecystitis,. However it is not without risks and might not be suitable for every patient