Treatment of brucellosis

Etiotropic therapy of active forms

Treatment of subacute brucellosis in the generalized stage requires the mandatory use of antibacterial drugs. The baseline etiotropic regimen involves the simultaneous administration of two drugs:

• Rifampicin: administered at a dose of 900 mg per day.
• Doxycycline: prescribed at 200 mg per day.

The duration of such a combination course is strictly 6 weeks. Shortening the treatment period is unacceptable, as it significantly increases the risk of relapse and progression of the infection to a chronic stage with the formation of persistent lesions in the joints and peripheral nervous system.

Pathogenetic and symptomatic treatment

Since brucellosis is accompanied by pronounced intoxication (fever up to 39°C, chills, drenching sweats) and systemic lesions, therapy must be comprehensive.

• Detoxification: in the presence of high fever, patients are shown heavy fluid intake.
• Anti-inflammatory therapy: non-steroidal anti-inflammatory drugs (e.g., Diclofenac or phenylbutazone) are prescribed to relieve pain in the joints, muscles, and in cases of radiculitis.
• Sedative support: prolonged illness is often accompanied by nervous system involvement (sleep disorders, irritability, tearfulness, emotional instability). In such cases, sedatives (e.g., seduxen) are indicated.
• Vitamin therapy: a complex of vitamins (C, B1, B6, B12) is included in the treatment regimen.

Therapy of chronic brucellosis

Chronic brucellosis (disease duration of more than 1.5 years) with the development of fibrositis and deforming arthritis requires a change in therapeutic tactics. In the stage of compensation or in the absence of recurrent generalization, the forefront is taken by:

1. Immunostimulatory therapy.
2. General strengthening agents (e.g., aloe preparations).
3. Sanatorium-resort treatment during the convalescence period.

Patients after undergoing the infection are subject to strict dispensary follow-up. Comprehensive clinical and laboratory examinations should be carried out every 5–6 months. Removal from the register is possible if there are no relapses for a long time (about 2 years).

Laboratory monitoring before starting therapy

Before starting antibiotic therapy, it is necessary to verify the diagnosis by ruling out sepsis, rheumatoid arthritis, Q fever, and borreliosis. For this purpose, the following are used:

• Bacteriological method (blood and urine culture).
• Serological methods: Wright's test, IHA, CFT, Coombs test, DFA.
• Detection of antigen in blood and urine (ELISA, RHA).
• Burnet skin allergy test.

Class and exam questions

What else to study on this topic

• Clinical presentation of subacute and chronic brucellosis
• Differential diagnosis with rheumatoid arthritis and sepsis
• Interpretation of serological test results (Wright's test, IHA)
• Significance of the Burnet test in allergodiagnostics
• Rules of dispensary monitoring for convalescents

Other topics in the section "Zoonotic infections — 2024 study guide"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.