Brucellosis treatment

Treatment of brucellosis depends on its clinical form.

The duration of hospitalization is 26 days for patients with acute brucellosis and 30 days for chronic brucellosis. Treatment of brucellosis includes antibacterial therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, desensitizing, detoxifying, vaccine, immunotherapy, physiotherapy and spa treatment.

Antibacterial treatment of brucellosis is carried out in acute septic and other forms of the disease in the presence of a febrile reaction. The duration of treatment is 1.5 months. One of the schemes is recommended:

Doxycycline orally 100 mg twice a day + streptomycin intramuscularly 1 g/day (first 15 days);

Doxycycline orally 100 mg twice a day + rifampicin orally 600-900 mg/day in 1-2 doses;

Co-trimoxazole orally 960 mg twice a day + rifampicin orally 600 mg 1-2 times a day or streptomycin intramuscularly 1 g once a day.

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

Due to the high efficiency of antibiotics, vaccine therapy is rarely used. A therapeutic brucellosis vaccine is used.

Therapeutic brucellosis vaccine - a suspension of sheep and bovine brucellosis, inactivated (for intradermal administration) or killed by heating (for intravenous administration), is produced in ampoules with an exact indication of the number of microbial cells in 1 ml. The standard concentration of the therapeutic brucellosis vaccine is 1 billion microbial cells in 1 ml of vaccine. The working concentration provides for 500 thousand microbial cells in 1 ml.

Subcutaneous and intradermal administration of the vaccine is the most common. Subcutaneously, the vaccine is prescribed for decompensation of the process and for pronounced clinical symptoms. An important principle of vaccine therapy is the individual selection of the drug dose. The severity of the reaction is judged by the intensity of the Burnet test. Subcutaneous administration usually begins with 10-50 million microbial cells. If there is no local or general reaction, then the vaccine is administered in an increased dose the next day. For treatment, a dose is selected that causes a moderate reaction. The next injection of the vaccine is given only after the reaction to the previous administration of the vaccine has disappeared. A single dose at the end of the course is increased to 1-5 billion microbial cells.

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

It should be taken into account that even with the complete disappearance of all clinical manifestations, 20-30% of patients with brucellosis may experience an exacerbation of the disease in the future.

Antihistamines (chloropyramine, mebhydrolin, promethazine) are used for desensitization in all forms of brucellosis. In case of damage to the musculoskeletal system (arthritis, polyarthritis), NSAIDs are indicated: diclofenac, ibuprofen, indomethacin, meloxicam, nimesulide, etc. If NSAIDs are ineffective, they are combined with glucocorticoids (prednisolone, dexamethasone, triamcinolone) in average therapeutic doses (30-40 mg of prednisolone orally) with a decrease in dose after 3-4 days. The duration of the course of treatment is 2-3 weeks. Glucocorticoids are also indicated for damage to the nervous system, orchitis.

Chronic forms of the disease, occurring with exacerbation, in the presence of changes in the immune status indicate immunosuppression. This is an indication for the appointment of immunomodulators (Imunofan, Polyoxidonium, etc.).

In case of lesions of the musculoskeletal system and peripheral nervous system, physiotherapy is recommended (inductotherapy, electrophoresis of novocaine, lidase, dimexide; ultra-high-frequency therapy, ion galvanotherapy, use of ozokerite, paraffin applications, massage, therapeutic exercises, etc.).

After the signs of the process activity disappear, the treatment of brucellosis should be combined with balneotherapy. Preference is given to local resorts. In case of neurovegetative disorders, hydrocarbonate, hydrosulphate-hydrogen sulphide, radon waters are indicated. Mud therapy is effective in case of lesions of the musculoskeletal system and peripheral nervous system.

Clinical examination

Those who have recovered from acute and subacute brucellosis are monitored for 2 years from the moment of illness, if there are no clinical and immunological signs of chronicity of the process. Those who have recovered are examined by a KIZ doctor in the first year after 1-3, 6, 9, 12 months, and during the second year - quarterly. During this time, they are subject to careful clinical and serological examination (Wright reaction, RPGA, Heddleson).

During the period of dispensary observation, preventive anti-relapse treatment for brucellosis is carried out in the first year at each examination, and during the second year - twice (in spring and autumn).

Those who have had acute and subacute brucellosis are removed from the dispensary register by a commission consisting of an infectious disease specialist, a therapist and an epidemiologist if no signs of chronicity of the process have been noted over the past 2 years of observation.

Patients with chronic brucellosis undergo a thorough clinical examination quarterly with mandatory thermometry and serological testing (Wright and RPGA reactions). During periods most unfavorable for the course of the disease (spring and autumn), anti-relapse treatment is necessary. Those who have recovered from chronic brucellosis are removed from the dispensary register in the same way as persons with acute and subacute brucellosis.

Patients with residual brucellosis are referred for treatment to appropriate specialists depending on the predominant damage to organs and systems.

Shepherds, milkmaids, veterinary workers, meat-packing plant workers and other professional groups are subject to constant dispensary observation during the entire period of work. Persons registered as suspected of brucellosis (with positive serological reactions or Burne's allergic test) without obvious clinical manifestations should be examined at least once a quarter. If the titer of serological reactions increases, patients are re-examined at least once every 2 months; if necessary, treatment is prescribed.

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Patient information sheet

It is recommended to employ convalescents rationally for 3-6 months with exemption from heavy physical labor and work in adverse weather conditions. Sanatorium and resort treatment of brucellosis is indicated for the chronic form of the disease no earlier than 3 months after remission.