Version July 2025
| Regimen | Dosing | |
| Nonpregnant adults* | Doxycycline | 100 mg orally twice daily for 6 weeks |
| plus | ||
| Streptomycin¶ | Weight >65 kg: 1 g IV or IM once daily for the first 14 to 21 days Weight ≤65 kg: 15 mg/kg IV or IM once daily for the first 14 to 21 days | |
| Doxycycline | 100 mg orally twice daily for 6 weeks | |
| plus | ||
| Gentamicin¶ | 5 mg/kg IV or IM once daily for the first 7 to 10 days | |
| Doxycycline | 100 mg orally twice daily for 6 weeks | |
| plus | ||
| Rifampin (rifampicin) | 600 to 900 mg orally once daily for 6 weeks | |
| Children ≥8 years | Doxycycline | 4.4 mg/kg per day (maximum 200 mg/day) orally in 2 divided doses for 6 weeks |
| plus | ||
| Rifampin (rifampicin) | 15 to 20 mg/kg per day (maximum 900 mg/day) orally once daily or in 2 divided doses for 6 weeks | |
| Doxycycline | 4.4 mg/kg per day (maximum 200 mg/day) orally in 2 divided doses for 6 weeks | |
| plus | ||
| Streptomycin¶ | 15 mg/kg per day (maximum 1 g/day) IV or IM in 1 to 2 doses for the first 14 to 21 days | |
| Doxycycline | 4.4 mg/kg per day (maximum 200 mg/day) orally in 2 divided doses for 6 weeks | |
| plus | ||
| Gentamicin¶ | 5 mg/kg IV or IM once daily for the first 7 to 10 days | |
| Children <8 years | Trimethoprim-sulfamethoxazole (TMP-SMX), cotrimoxazole | 10 mg/kg (trimethoprim component) per day (maximum 320 mg/day) orally in 2 divided doses for 6 weeks |
| plus | ||
| Rifampin (rifampicin) | 15 to 20 mg/kg per day (maximum 900 mg/day) orally once daily or in 2 divided doses for 6 weeks | |
| Pregnant patients <36 weeks gestationΔ | TMP-SMX, cotrimoxazole | 1 double-strength tablet (160 mg trimethoprim/800 mg sulfamethoxazole) orally 2 daily for 6 weeks Trimethoprim component is a folic acid antagonist; to assure adequate maternal and fetal levels, we supplement with additional folic acid (eg, 0.8 to 1 mg orally once daily) during the first trimester of pregnancy. |
| plus | ||
| Rifampin (rifampicin) | 600 to 900 mg orally once daily for 6 weeks | |
IM: intramuscularly; IV: intravenously.
* Preferred regimens for nonpregnant adults are summarized in the table; alternative regimens are discussed in the UpToDate topic on treatment and prevention of brucellosis.
¶ In non-obese, average-weight adult patients, the initial aminoglycoside dose is based on ideal body weight. Kidney function and aminoglycoside serum concentrations should be monitored at least once per week. Dosing listed is recommended for patients with normal kidney function; the initial dose should be adjusted in patients with kidney impairment and as needed to attain target serum concentrations. For further guidance, refer to the UpToDate topic on dosing and administration of parenteral aminoglycosides and the streptomycin and gentamicin drug-specific monographs.
Δ For pregnant women ≥36 weeks gestation, we administer rifampin monotherapy until delivery, given risk of neonatal kernicterus with use of TMP-SMX in the last month of pregnancy. After delivery, we continue combination therapy as in nonpregnant adults; the total duration of treatment is 6 weeks.