Brucellosis treatment

The treatment of brucellosis depends on its clinical form.

The length of hospitalization is 26 days for patients with acute brucellosis and 30 days for chronic brucellosis. Treatment of brucellosis includes antibacterial therapy, non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, desensitizing, detoxification, vaccine, immuno-, physiotherapy and sanatorium treatment.

Antibacterial treatment of brucellosis is carried out with acute and other forms of the disease in the presence of a febrile reaction. Duration of treatment is 1.5 months. Recommend one of the schemes:

Doxycycline is administered 100 mg twice a day + streptomycin IM / 1 g / day (first 15 days);

Doxycycline is administered 100 mg twice a day + rifampicin by mouth at 600-900 mg / day in 1-2 doses;

Co-trimoxazole is administered orally 960 mg twice daily + rifampicin orally 600 mg 1-2 times daily or streptomycin IM per 1 g once daily.

Combinations of doxycycline with gentamicin and rifampicin with ofloxacin are also effective.

Due to the high effectiveness of antibiotics, vaccine therapy is rarely used. Use a curative brucellosis vaccine.

Curative brucellosis vaccine - a suspension of brucellae of sheep and bovine form, inactivated (for intradermal administration) or killed by heating (for intravenous administration), is issued in ampoules with an accurate indication of the number of microbial cells in 1 ml. The standard concentration of the curative brucellosis vaccine is 1 billion microbial cells per 1 ml of the vaccine. The working concentration provides 500 thousand microbial cells per ml.

The most common is subcutaneous and intradermal injection of the vaccine. Subcutaneously the vaccine is prescribed for decompensation of the process and with severe clinical symptoms. An important principle of vaccine therapy is individual dose selection. The severity of the reaction is judged by the intensity of the Burne test. Subcutaneous injection often begins with 10-50 million microbial cells. If the local and general reaction is absent, then the vaccine in an increased dose is administered the next day. For treatment, select a dose that causes a mild reaction. The next injection of the vaccine is done only after the reaction to the previous administration of the vaccine has disappeared. A single dose at the end of the course is adjusted to 1-5 billion microbial cells.

Intradermal vaccine therapy is more gentle. This method is used in the compensation stage, as well as in the transition of the disease into a latent form. By the severity of the skin reaction, the working dilution of the vaccine is selected (it should cause a local reaction in the form of skin hyperemia with a diameter of 5-10 mm). The vaccine is injected intradermally into the palmar surface of the forearm on the first day of 0.1 ml in three places, then every day add one injection and bring on the 8th day to 10 injections. If the response to the vaccine decreases, use a smaller dilution.

It should be borne in mind that even with the complete disappearance of all clinical manifestations, in 20-30% of patients with brucellosis there may be an exacerbation of the disease in the future.

For the purpose of desensitization in all forms of brucellosis, antihistamines (chloropyramine, mebhydroline, promethazine) are used. NSAIDs are combined with glucocorticoids (prednisolone, dexamethasone, triamcinolone) at average therapeutic doses (30-40 mg of prednisolone orally) with a decrease in dose after 3-4 days. Duration of treatment 2-3 weeks. Glucocorticoids are also shown when the nervous system, orchites, is affected.

Chronic forms of the disease, which occur with exacerbation, in the presence of changes in the immune status indicate immunosuppression. This indication for the appointment of immunomodulators (imunofan, polyoxidonium, etc.).

When the musculoskeletal system and the peripheral nervous system are damaged, physiotherapy is recommended (inducer therapy, Novocain electrophoresis, lidase, dimexide, ultrahigh-frequency therapy, ionogalvanotherapy, ozokerite application, paraffin applications, massage, medical gymnastics, etc.).

After the signs of process activity disappear, the treatment of brucellosis should be combined with balneotherapy. The advantage is given to local resorts. In neurovegetative disorders, hydrocarbonate, hydrosulphate-hydrogen sulfide, radon waters are shown. With lesions of the musculoskeletal system and the peripheral nervous system, mud therapy is effective.

Clinical examination

The patients with acute and subacute brucellosis are under observation for 2 years from the moment of the disease, if there are no clinico-immunological signs of the process chronicization. The patient is examined by a physician of the KIZ in the first year at 1-3, 6, 9, 12 months, and during the second year - quarterly. At this time they are subject to a thorough clinical and serological examination (Wright, RPGA, Haddleson reaction).

During the dispensary follow-up, prophylactic anti-relapse treatment of brucellosis is performed in the first year at each examination, during the second year - twice (in spring and in autumn).

Having recovered from acute and subacute brucellosis from the dispensary record, a commission is selected consisting of an infectious disease physician, a therapist and an epidemiologist in the event that during the last 2 years no signs of process chronicization have been observed.

Patients with chronic brucellosis quarterly conduct a thorough clinical examination with mandatory thermometry and serological examination (Wright and RPGA reactions). In periods that are most unfavorable for the course of the disease (in spring and autumn), antiretroviral treatment is necessary. Those who have recovered from chronic brucellosis are removed from dispensary records as well as persons with acute and subacute brucellosis.

Patients with residual brucellosis are referred for treatment to appropriate specialists, depending on the primary lesion of organs and systems.

Shepherds, milkmaids, veterinarians, meat-packing plant workers and other professional groups are subject to constant follow-up during the whole period of work. Persons registered as suspected brucellosis (with positive serological reactions or allergic Burne test) without obvious clinical manifestations should be examined at least once a quarter. If the titer of serological reactions increases, patients are repeatedly examined at least once every 2 months. If necessary, prescribe a treatment.

[1], [2], [3], [4], [5], [6]

Memo for the patient

Recommended rational employment of reconvalescents for 3-6 months with exemption from heavy physical labor and work in adverse weather conditions. Sanatorium treatment of brucellosis is indicated in the chronic form of the disease not earlier than 3 months after remission.