Comparison of doxycycline-streptomycin, doxycycline-rifampin, and ofloxacin-rifampin in the treatment of brucellosis: A randomized clinical trial
Seyyed Hamid Hashemi
Mohammad Mehdi Majzoobi
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Background: Traditional regimens for the treatment of brucellosis are associated with significant relapse rates. The aim of this study was to compare the efficacy of ofloxacin plus rifampin (OFX-RIF) versus doxycycline plus streptomycin (DOX-STR) and doxycycline plus rifampin (DOX-RIF) regimens in the treatment of brucellosis. Methods: Two hundred and nineteen patients with brucellosis were enrolled in a randomized clinical trial; 28 cases were withdrawn because they did not attend the follow-up. Out of 191 patients with brucellosis, 64 received OFX-RIF, 62 received DOX-RIF, and 65 patients received DOX-STR regimens. All patients were assessed during the period of therapy in the second, fourth, and sixth weeks by clinical course and were also followed up clinically and serologically for 6 months after the cessation of therapy. Results: The highest clinical response (95.4%) was observed in the DOX-STR group (. p=. 0.009). The results of multivariate analysis indicate that treatment with DOX-STR had the least therapeutic failures among the three groups (. p=. 0.033). Adverse reactions were seen in 16.8% of patients, but there was no significant difference among the three groups (. p=. 0.613). The lowest relapse rate (4.6%) was observed in the DOX-STR group (. p=. 0.109). Conclusions: We conclude that the DOX-STR combination should remain the first-line regimen for the treatment of brucellosis in our region; we recommend DOX-RIF and OFX-RIF combinations as the second-line regimens. © 2012 International Society for Infectious Diseases.