Brucellosis Treatment: Rifampicin vs Streptomycin

Treatment with rifampicin was associated with a higher incidence of overall treatment failure and relapse in patients with brucellosis compared with patients treated with streptomycin, according to research published in PLos ONE.

Brucellosis, a zoonotic bacterial infection common in the developing world, is often treated with a combination of antibacterial drugs; however, optimal treatment regimens have not yet been determined. A meta-analysis of studies using a randomized controlled design was used to evaluate the effect of streptomycin vs rifampicin in patients with brucellosis receiving doxycycline therapy as a background regimen.

In total, 1383 patients from 14 trails were included in the analysis, which showed that patients receiving rifampicin therapy had a higher risk for overall failure (risk ratio [RR] 2.36; 95% CI, 1.72-3.23; P <.001) and relapse (RR 2.74; 95% CI, 1.8-4.19; P <.001) compared with patients receiving streptomycin. 

Sensitivity analysis results were consistent with this finding, but mean age and percentage of male participants might influence the treatment effects according to subgroup analysis.  No significant difference was observed in patients with a mean age >40.

The results indicate increased risk for treatment failure with rifampicin but investigators report several important study limitations and advise caution when interpreting the results. First, because data was obtained from published trials, publication biases may have existed and investigators deemed many of the published trials to be of low quality. Therefore, results may vary and further work is required to explore the influence of age and gender on treatment effect and to find more effective treatment strategies.

Reference

Meng F, Pan X, Tong W. Rifampicin versus streptomycin for brucellosis treatment in humans: A meta-analysis of randomized controlled trials. PLoS One. 2018;13:e0191993.