Treatment of Brucellosis in Pediatric Patients

First-Line Treatment for Pediatric Brucellosis

The American Academy of Pediatrics recommends rifampicin (15-20 mg/kg/day) combined with trimethoprim-sulfamethoxazole (TMP-SMX: 10-12 mg/kg trimethoprim component) given orally for 6 weeks as the preferred first-line regimen for children under 8 years old with brucellosis 1
For children 8 years and older, the World Health Organization recommends doxycycline (100 mg twice daily) plus streptomycin (15 mg/kg daily IM) for 2-3 weeks or gentamicin (5 mg/kg daily IV) for 7 days as first-line treatment options 1, 2
The Centers for Disease Control and Prevention suggests doxycycline (100 mg twice daily) plus rifampicin (600-900 mg daily) for 6 weeks as an alternative regimen when aminoglycosides are contraindicated 1, 2

A cost-effectiveness analysis found that the rifampicin-TMP-SMX combination is a cost-effective treatment option for pediatric brucellosis, avoiding the toxicity and expense of aminoglycosides 3

The standard treatment duration for uncomplicated brucellosis is 6 weeks, and pediatric studies have shown no significant difference between 3, 5, or 8 weeks when using combination therapy 1, 2
TMP-SMX monotherapy has unacceptably high failure rates (30%) and should only be used in combination with rifampicin or as a third agent 3, 4
Aminoglycoside-containing regimens, such as streptomycin or gentamicin combined with doxycycline, provide the lowest relapse rates for children 8 years and older 1, 2

For brucellar spondylitis, aminoglycoside-containing regimens may be superior to rifampicin-containing ones, and MRI should always be performed when spinal involvement is suspected 2, 4, 5
For neurobrucellosis, aminoglycoside-containing regimens (preferably gentamicin) combined with doxycycline and rifampicin should be considered, and treatment duration typically extends to 3-6 months 5

In areas where tuberculosis and brucellosis coexist, the public health implications of rifampicin use should be considered, as widespread use may contribute to mycobacterial resistance 1, 2
In resource-limited settings, the rifampicin-TMP-SMX combination offers significant cost advantages while maintaining efficacy 3

Relapse rates range from 5-15% even with appropriate treatment, and relapses are usually mild and respond well to retreatment with the same regimen 1, 2