Melioidosis Treatment and Management

Antibiotic Therapy

For patients with melioidosis-induced septic shock, meropenem plus granulocyte colony-stimulating factor (G-CSF) has been used successfully, as demonstrated in studies published in the British Journal of Pharmacology 1, 2
B. pseudomallei isolates are sensitive to meropenem and imipenem but resistant to ertapenem, azithromycin, and moxifloxacin, according to in vitro testing results published in the British Journal of Pharmacology 2, 3
Amoxicillin-clavulanate is less effective than first-line options but may be used for pregnant women, children, and patients with intolerance to first-line therapy, as reported in the British Journal of Pharmacology 2, 4

TMP-SMX is recommended for post-exposure prophylaxis in case of biological attack and for immunosuppressed patients, as suggested by studies published in the British Journal of Pharmacology 5
When administered within 24 hours post-infection, co-trimoxazole has shown 100% survival rates in animal studies, according to research published in the British Journal of Pharmacology 1, 5
As pre-exposure prophylaxis, doxycycline and co-trimoxazole have demonstrated survival rates of 80% and 100% respectively in animal models, as reported in the British Journal of Pharmacology 1, 5
Amoxicillin-clavulanic acid is not suitable as a prophylactic against melioidosis based on animal studies published in the British Journal of Pharmacology 1, 5

Phage-displayed non-immune human single-chain Fv antibody libraries against B. pseudomallei have identified potential therapeutic reagents, as described in research published in the British Journal of Pharmacology 2, 3
A Taiwanese patient with life-threatening melioidosis was successfully treated with a combination of meropenem and recombinant-activated protein C (rhAPC), according to a case report published in the British Journal of Pharmacology 2, 3
Various vaccine candidates are being developed, including B. pseudomallei surface proteins and proteins of the ATP-binding cassette system, as reported in studies published in the British Journal of Pharmacology 5, 6

The American College of Physicians recommends intravenous antibiotics for at least 14 days for the initial intensive phase of melioidosis treatment 7, 8
First-line options for the initial intensive phase include Ceftazidime (100 mg/kg/day) 7
Meropenem or imipenem are preferred for severe cases of melioidosis 9, 8
Longer intensive treatment is required for critical illness, extensive pulmonary disease, deep-seated collections or organ abscesses, osteomyelitis, septic arthritis, and neurologic melioidosis 8

The Infectious Diseases Society of America recommends TMP-SMX (Septarn) as the drug of choice for the eradication phase of melioidosis treatment 8
The duration of the eradication phase is 3-6 months 7, 8

TMP-SMX monotherapy for 20 weeks has been shown to be as effective as combination therapy with TMP-SMX plus doxycycline in preventing relapse 7

If TMP-SMX is not tolerated or contraindicated, alternatives include Amoxicillin-clavulanate and Doxycycline 7, 8

B. pseudomallei is inherently resistant to many antibiotics, including penicillin, ampicillin, first- and second-generation cephalosporins, gentamicin, streptomycin, and polymyxin 7, 8

For pregnant women with similar treatment considerations, long-term co-trimoxazole therapy is recommended to decrease the risk of complications 10
For children, the WHO recommends co-trimoxazole at a dose of 4 mg/kg trimethoprim plus 20 mg/kg sulfamethoxazole twice daily for various infections 11