Regimens for treatment of brucellosis (in absence of focal disease due to spondylitis, neurobrucellosis, or endocarditis)

	Regimen	Dosing
Nonpregnant adults	Doxycycline	100 mg orally twice daily for 6 weeks
	plus
	Streptomycin	1 g intramuscularly or intravenously once daily for the first 14 to 21 days
	Doxycycline	100 mg orally twice daily for 6 weeks
	plus
	Gentamicin	5 mg/kg/day intramuscularly or intravenously in 1 dose; usual duration 7 to 10 days
	Doxycycline	100 mg orally twice daily for 6 weeks
	plus
	Rifampin	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	15 to 20 mg/kg per day (maximum 900 mg/day) orally once daily 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 to 40 mg/kg per day (maximum 1 g/day) intramuscularly or intravenously 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/day intramuscularly or intravenously in 1 dose; usual duration 7 to 10 days
Children <8 years	TMP-SMX	TMP 10 mg/kg per day (maximum 320 mg/day) and SMX 50 mg/kg per day (maximum 1.6 g/day) divided in 2 doses for 6 weeks
	plus
	Rifampin	15 to 20 mg/kg per day (maximum 900 mg/day) orally once daily for 6 weeks
Pregnant women*	TMP-SMX	1 double-strength tablet (160 mg TMP/800 mg SMX) orally twice daily for 6 weeks
	plus
	Rifampin	600 to 900 mg orally once daily for 6 weeks

TMP-SMX: trimethoprim-sulfamethoxazole.
* 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.

Data from: American Academy of Pediatrics. Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021.

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Regimens for treatment of brucellosis (in absence of focal disease due to spondylitis, neurobrucellosis, or endocarditis)