Dosing of Trimethoprim-Sulfamethoxazole for Melioidosis

Treatment Protocol for Melioidosis

The American College of Physicians recommends treatment begins with an intensive phase of at least 14 days using intravenous antibiotics such as ceftazidime, meropenem, or imipenem for patients with melioidosis 1, 2
Longer intensive treatment is required for patients with critical illness, extensive pulmonary disease, deep-seated collections or organ abscesses, osteomyelitis, septic arthritis, and neurologic melioidosis 1, 2, 3
For severe melioidosis, meropenem has demonstrated better clinical outcomes than ceftazidime 1, 3

The Infectious Diseases Society of America recommends TMP-SMX as the drug of choice for the eradication phase to prevent recrudescence or relapses in patients with melioidosis 1, 2, 4
The recommended duration for the eradication phase is 3-6 months 1, 2

For a typical adult, the standard dosing of TMP-SMX for melioidosis eradication phase is a double-strength tablet (160 mg trimethoprim/800 mg sulfamethoxazole) twice daily, as recommended by the Centers for Disease Control and Prevention 5

The American College of Physicians recommends amoxicillin-clavulanate and doxycycline as alternatives for eradication phase therapy if TMP-SMX is not tolerated or contraindicated in patients with melioidosis 1, 2

B. pseudomallei is inherently resistant to many antibiotics, including penicillin, ampicillin, first- and second-generation cephalosporins, gentamicin, streptomycin, and polymyxin, as reported by the World Health Organization 1, 2, 3
TMP-SMX is also recommended for post-exposure prophylaxis in case of biological attack and for immunosuppressed patients by the British Society for Antimicrobial Chemotherapy 4, 6