Sulfamethoxazole-trimethoprim plus rifampicin most used treatment for brucellosis

In the treatment of children with brucellosis, the most prescribed antibiotic therapy is sulfamethoxazole-trimethoprim plus rifampicin, reports a study.

In this systematic review, the investigators examined the efficacy and safety of antimicrobial regimens for treating human brucellosis in children. They included original human studies with clinical outcomes after drug therapy intervention for children up to 10 years old.

The databases of Medline, Embase, Cochrane Library, and LILACS were searched for studies indexed until 6 March 2023. Two reviewers carried out the study selection, data extraction, and bias risk assessment.

To evaluate the quality of the studies, the investigators used Joanna Briggs Institute tools and the grading of recommendations assessment, development, and evaluation (GRADE) system. They then analysed the obtained data using R software.

Over 1,700 records were reviewed, which yielded 11 eligible studies involving 1,156 children. All studies were observational.

The most common treatment strategies applied were sulfamethoxazole-trimethoprim with rifampicin (summarized failure rate, 2 percent, 95 percent confidence interval [CI], 0.0–0.49) and aminoglycosides (summarized failure rate, 13 percent, 95 percent CI, 0.06–0.29), based on studies with very low certainty of evidence.

Notably, adverse events and time to defervescence were not reported.

“The study highlights the need for more research with robust designs and emphasizes uncertainty regarding the efficacy of antimicrobial regimens, [highlighting] the importance of further investigations to guide specific treatment protocols for this population,” the investigators said.