Regimens for treatment of neurobrucellosis

	Regimen	Dosing
Nonpregnant adults	Ceftriaxone	2 g intravenously twice daily for the first 4 to 6 weeks
	plus
	Rifampin	600 to 900 mg orally once daily for at least 12 weeks
	plus
	Doxycycline	100 mg orally twice daily for at least 12 weeks
Children ≥8 years	Ceftriaxone	100 mg/kg per day divided in 2 doses; (maximum daily dose 4 grams per day) for the first 4 to 6 weeks
	plus
	Rifampin	15 to 20 mg/kg per day (maximum 900 mg/day) orally once daily for at least 12 weeks
	plus
	Doxycycline	4.4 mg/kg per day (maximum 200 mg/day) orally in 2 divided doses for at least 12 weeks
Children <8 years	Ceftriaxone	100 mg/kg/day divided every 12 hours (maximum 2 g per dose) for the first 4 to 6 weeks
	plus
	Rifampin	15 to 20 mg/kg per day (maximum 900 mg/day) orally once daily for at least 12 weeks
	plus
	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 at least 12 weeks
Pregnant women*	Ceftriaxone	2 g intravenously twice daily for the first 4 to 6 weeks
	plus
	Rifampin	600 to 900 mg daily orally once daily for at least 12 weeks
	plus
	TMP-SMX	1 double-strength tablet (160 mg TMP/800 mg SMX) orally twice daily for at least 12 weeks

TMP-SMX: trimethoprim-sulfamethoxazole.
* For pregnant women ≥36 weeks gestation, we administer ceftriaxone and rifampin 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 12 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 neurobrucellosis