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Duration of antibiotic therapy for Burkholderia pseudomallei infections (melioidosis)

Duration of antibiotic therapy for Burkholderia pseudomallei infections (melioidosis)
Antibiotic duration determining focus Minimum intensive phase duration* Eradication phase duration
Skin abscess 2 weeks 3 months
Bacteremia with no focus 2 weeks 3 months
Pneumonia
  • Unilateral unilobar pneumonia without lymphadenopathyΔ or ICU admission, and with negative blood cultures
2 weeks 3 months

  • Multilobar unilateral or bilateral pneumonia without lymphadenopathyΔ or ICU admission, and with negative blood cultures

    OR

    Unilateral unilobar pneumonia without lymphadenopathyΔ or ICU admission, but with positive blood cultures
3 weeks 3 months

  • Pneumonia with either lymphadenopathyΔ or ICU admission

    OR

    Multilobar unilateral or bilateral pneumonia with positive blood cultures
4 weeks 3 months
Deep-seated collection◊ 4 weeks§ 3 months
Osteomyelitis 6 weeks 6 months
Central nervous system infection 8 weeks 6 months
Arterial infection (most commonly mycotic aneurysm) 8 weeks§ 6 months or longer¥
ICU: intensive care unit; CNS: central nervous system.
* Use clinical judgement to guide prolongation of the intensive phase if improvement is slow or if blood cultures remain positive at 7 days.
¶ If concurrent oral therapy is not indicated in the intensive phase, oral eradication therapy should begin at the start of the final week of planned intensive intravenous therapy. The timing of the duration of eradication therapy starts the day after the last intravenous therapy.
Δ Defined as enlargement of any hilar or mediastinal lymph node to greater than 10 mm diameter.
◊ Defined as an abscess anywhere other than skin, lungs, bone, CNS, or vasculature. Septic arthritis is considered a deep-seated collection.
§ The timing of the duration of the intensive phase starts from the date of the most recent drainage/resection where specimen cultures grew Burkholderia pseudomallei or where no specimen was sent for culture. The clock is not reset if the specimen is culture-negative.
¥ Life-long suppressive antibiotic therapy may be required following vascular prosthetic surgery.
From: Sullivan RP, Marshall CS, Anstey NM, et al. 2020 Review and revision of the 2015 Darwin melioidosis treatment guideline; paradigm drift not shift. PLoS Negl Trop Dis 2020; 14:e0008659. Available at: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008659. Copyright © 2020 Sullivan et al. Reproduced under the terms of the Creative Commons Attribution License 4.0.
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