Treatment of Melioidosis / Lao Medical Journal

ABSTRACT

Melioidosis is recognized with increasing frequency in the Lao PDR, and is probably far more common than is currently appreciated. Recommendations for the antibiotic treatment of melioidosis are based on good evidence from a series of large clinical trials conducted mainly in northeast Thailand over the past 25 years. This review summarizes that evidence and considers it in a Lao context. Treatment is usually divided into 2 phases in the first, or acute phase, parenteral drugs are given for at least 10 days with the aim of preventing death from overwhelming sepsis; in the second, or eradication phase, oral drugs are given, usually to complete a total of 20 weeks, with the aim of preventing relapse. Within these broad generalisations, specific treatment for individual patients needs to be tailored according to clinical manifestations and response, and there remain many unanswered questions. Some patients with very mild infections can probably be cured by oral agents alone. In the Lao PDR, ceftazidime is used for the acute phase, with co-amoxiclav as second line therapy. Co¬trimoxazole plus doxycycline is preferred for the eradication phase, with the alternative of co¬amoxiclav. It is likely that clinical trial evidence will soon support the use of co¬trimoxazole alone. In all cases, the best available supportive care is needed, along with drainage of abscesses whenever possible. Treatment for melioidosis is extremely expensive, but the relative costs have reduced over the past decade. Unfortunately there is no likelihood of any new or cheaper options becoming available in the immediate future.