A prospective comparison of co-amoxiclav and the combination of chloramphenicol, doxycycline, and co-trimoxazole for the oral maintenance treatment of melioidosis

Trans R Soc Trop Med Hyg. Sep-Oct 1995;89(5):546-9. doi: 10.1016/0035-9203(95)90104-3.

Abstract

An open randomized comparison of the oral 'conventional' regimen (combination of chloramphenicol, cotrimoxazole and doxycycline) and co-amoxiclav for the maintenance treatment of melioidosis was conducted in Ubon Ratchatani, north-eastern Thailand, between 1989 and 1992. The total antibiotic treatment duration was 20 weeks. Of 101 patients followed, 10 (10%; 95% confidence interval [CI] 4.9-17.5%) subsequently relapsed: 2 of 52 patients (4%) in the oral 'conventional' group, and 8 of 49 patients (16%) receiving oral co-amoxiclav. This compares with a relapse rate of 23% in our previous study of 8 weeks' total therapy. Only 50% of patients complied with the 20 weeks' treatment regimen and poor compliance proved the most significant risk factor for subsequent relapse (relative risk [RR] 4.9, 95% CI 1.2-20.3). Neither the presence of known underlying disease nor choice of initial parenteral treatment was significantly associated with a higher risk of relapse. Co-amoxiclav is safer and better tolerated, but may be less effective (RR of relapse 0.4, 95% CI 0.2-1.2) than the oral 'conventional' regimen. The minimum duration of total treatment with either regimen should be 12-20 weeks, depending on clinical progress.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Amoxicillin / therapeutic use
  • Amoxicillin-Potassium Clavulanate Combination
  • Chloramphenicol / therapeutic use
  • Clavulanic Acids / therapeutic use
  • Doxycycline / therapeutic use
  • Drug Therapy, Combination / adverse effects
  • Drug Therapy, Combination / therapeutic use*
  • Female
  • Humans
  • Long-Term Care
  • Male
  • Melioidosis / drug therapy*
  • Melioidosis / mortality
  • Middle Aged
  • Patient Compliance
  • Prospective Studies
  • Recurrence
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Clavulanic Acids
  • Chloramphenicol
  • Amoxicillin-Potassium Clavulanate Combination
  • Amoxicillin
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Doxycycline