Treatment of Melioidosis

Infect Dis Clin North Am. 2026 Mar;40(1):127-147. doi: 10.1016/j.idc.2025.12.002. Epub 2026 Jan 21.

Abstract

Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative environmental saprophyte found in tropical and subtropical regions globally. The aims of treatment for melioidosis are to prevent death and other complications of septic shock, and to eradicate B. pseudomallei and prevent relapse. To achieve these aims, treatment comprises an intensive phase involving minimum 10-14 days of intravenous ceftazidime, meropenem, or imipenem, and a prolonged eradication phase of at least 3 months of oral trimethoprim-sulfamethoxazole. Here, we review the clinical trial and other evidence that supports melioidosis treatment guidelines, and the approach to complications including treatment side effects, relapse, and antimicrobial resistance.

Keywords: Antimicrobial resistance; Burkholderia pseudomallei; Melioidosis; Treatment.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / therapeutic use
  • Burkholderia pseudomallei* / drug effects
  • Ceftazidime / therapeutic use
  • Humans
  • Melioidosis* / drug therapy
  • Melioidosis* / microbiology
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Ceftazidime
  • Trimethoprim, Sulfamethoxazole Drug Combination