Efficacy and safety of co-trimoxazole in eradication phase of melioidosis; systematic review

Keragala, Keragala Arachchige Reshani Kaumada; Gunathilaka, Maththe Gama Ralalage Shobha Sanjeewani; Senevirathna, Rathnabahu Mudiyanselage Indika Sanjeewa Kumara; Jayaweera, Jayaweera Arachchige Asela Sampath

doi:10.1186/s12941-023-00620-z

Annals of Clinical Microbiology and Antimicrobials

Table 1 Summary of case reports where co-trimoxazole is used as eradication therapy

From: Efficacy and safety of co-trimoxazole in eradication phase of melioidosis; systematic review

Study	Study design	Site of infection	Drugs used in eradication phase	Dose	Duration	Side effects	Outcomes
Saravu et. al. [40]	Case series	Case 1—liver, blood, lungs		Not given	Not given
		Case 2- liver, spleen, lungs, bones	Oral co-amoxiclav and Oral Co-trimoxazole	Not given	24 weeks	Weight gain	Splenomegaly completely regressed; hip pain subsided
		Case 3-liver, spleen		Not given	Not given
		Case 4- liver, spleen, rain		Not given	Not given
		Case 5-spleen, Liver, lungs, blood		Not given	Not given		Septic shock, ARDS, death
		Case 6- mediastinum	Oral co-amoxiclav and Co-trimoxazole	Not given	Not given		Lost follow up
		Case 7- spleen, blood	Oral co-amoxiclav and Co-trimoxazole	Not given	14 weeks		Symptoms free at 6 months
Nandasiri et al. [41]	Case report	Spinal cord, bones, psoas abscess	Oral Co-trimoxazole oral doxycycline	Not given	52 weeks		The residual neurological deficits including the paraplegia, complete sensory loss and sphincter disturbance persisted
Weerasinghe et al. [42]	Case report	Bone- hip joint	Oral Co-trimoxazole	Not given	10 weeks		Symptoms resolved
Owen et al. [43]	Case report	Brain	Oral Co-trimoxazole	Not given	Not given
Shrestha et al. [44]	Case report	Case 1—liver, soft tissues, lungs	Oral doxycycline and oral Co-trimoxazole	oral doxycycline [100 mg 12 hourly] and oral Co-trimoxazole (960 mg once daily) for three months	12 weeks
		Case 2- spleen	Oral doxycycline and oral Co-trimoxazole		12 weeks
Karunarathna et al. [45]	Case report	Bones, soft tissues	Oral Co-trimoxazole		24 weeks		Symptoms resolved
Martin et al. [46]	Case report	Liver	Oral Co-trimoxazole	Oral co- trimoxazole 800/160 mg twice a day	12 weeks		Symptoms resolved
Phillips et al. [47]	Case report	Sinuses	Oral Co-trimoxazole (Bactrim®)	Oral co-trimoxazole (Bactrim^®) 160 mg/800 mg twice daily for 14 weeks	14 weeks		Culture negative for B. psuedomallei
Mabayoje et al. [48]	Case report	Knee joint	Oral doxycycline and Oral Co-trimoxazole	Oral co-trimoxazole (960 mg 2 × /d; 160 mg of trimethoprim and 800 mg of sulfamethoxazole) and doxycycline (100 mg 2 × /d)	8 weeks		Had full range of movements of the knee joints
Huang et al. [49]	Case report	Joints, lungs	Oral Co-trimoxazole	960 mg tablets of oral Co-trimoxazole every 12hourly	24 weeks		Symptoms resolved and no relapses occurred
Jayawardena et al. [50]	Case report	Soft tissues	Oral Co-trimoxazole	Oral co-trimoxazole 960 mg 12-hourly	24 weeks		Symptoms resolved
Rahim et al. [51]	Case reports	Kidney	Oral doxycycline and Oral Co-trimoxazole	Oral co-trimoxazole (960 mg Q 12 h) and doxycycline (100 mg Q 12 h)	20 weeks		Symptoms resolved and no relapses occurred
Zaw et al. [52]	Case report	Lungs	Oral Co-trimoxazole	Oral co-trimoxazole (800 mg/160 mg) 2 tablets twice a day with daily folic acid5mg	12 weeks		Symptoms resolved
Nair et al. [53]	Case report	Ankle joint	Oral Co-trimoxazole	Oral co-trimoxazole 160 mg/800 mg	20 weeks		Normal weight bearing in 6 months
Soo et al. [21]	Case report	Lungs	Oral doxycycline and Oral Co-trimoxazole	oral doxycycline 100 mg 12 hourly and three tablets of co-trimoxazole 80/400 mg (TMP-SMX) 12hourly	20 weeks		Symptoms resolved
Commons et al. [54]	Case report	Lungs	Oral Co-trimoxazole	Oral co-trimoxazole 1600/320 mg bd	6 weeks given (intended duration 3 months)	Agitation, exacerbation of psoriatic skin lesions and thrush	Due to adverse effects drug changed into amoxicillin-clavulanic acid (500/125 mg 3mane, 2 midi, 3 nocte).1The patient continued this treatment for the remaining 6 weeks of eradication therapy. Then symptoms resolved
Wijekoon et al. [55]	case report	Liver, spleen and CSF	Oral Co-trimoxazole and Co-amoxiclav	Oral co-trimoxazole 1920 mg 12hourly and co-amoxiclav 625 mg 8 h	12 weeks		No relapse or weakness
Pitman et al. [67]	Case report	Brain and bones	Oral Co-trimoxazole	Oral co-trimoxazole (TMP-SMX) at the dose of 3 × 80 mg of TMP–400 mg of SMX (480 mg), every 12 h	24 weeks		No Neurological deficits occurred and symptoms were resolved
Antony et al. [56]	Case report	Central nervous system	Oral Co-trimoxazole	Oral co-trimoxazole (TMP 320 mg/SMX1600mg) two times per day	12 weeks		The facial palsy showed improvement
Kuijpers et al. [57]	Case report	Skin and soft tissues	Oral Co-trimoxazole	oral trimethoprim–sulfamethoxazole 1920 mg every 12 h	6 weeks / 3 months		No recurrence of the skin abscess was observed
Ding et al. [58]	case report	Left infrarenal aortic aneurysm	Oral Co-trimoxazole and doxycycline	Co-trimoxazole (320 mg/1600 mg) bd and oral doxycycline 100 mg bd	20 weeks		Symptoms resolved
Sachindra et al. [59]	Case report	Lungs, kidneys and brain	Oral Co-trimoxazole	Co-trimoxazole (1920 mg 12 hourly	12 weeks		Resolved completely
Redondo et al. [60]	Case report	Bones	Oral Co-trimoxazole and doxycycline	oral doxycycline (100 mg every 12 h) and Oral co-trimoxazole (1double strength tablet every 12 h)	48 weeks		Symptoms resolved
Vaid et al. [61]	Case report	Temporomandibular joint (TMJ)	Oral Co-trimoxazole	Oral co-trimoxazole 240/1200 mg orally twice a day	24 weeks		Symptoms resolved
Saonanon,et al. [62]	Case report	Case 2-Orbit	Oral Co-trimoxazole and doxycycline	Co-trimoxazole (80/400 mg) 2 tablets 3 times a day in combination with doxycycline (100 mg) 1 tablet twice a day	24 months		The patient had showed no relapse, OD visual acuity was 20/30 and he had a noticeable scar on his forehead
Lee et al. [63]	Case report	Case 1—Liver, spleen	Oral Co-trimoxazole		32 months		No relapse for 2 years
		Case 2—Liver, spleen, prostate, lungs	Oral Co-trimoxazole	Oral Use co-trimoxazole (TMP 80 mg; SMX400 mg) two tablets every 6 h	6 weeks		Patient was clinically well
Svensson et al. [64]	Case report	Soft tissues	Oral Co-trimoxazole and doxycycline	Oral eradication therapy with doxycycline (100 mg) and Oral Co-trimoxazole (160 mg/800 mg) twice daily was then started	20 weeks	nausea	No recurrence observed
Shrestha et al. [65]	Case report	Lungs	Oral Co-trimoxazole (TMP/SMX)	Oral co-trimoxazole (TMP/SMX) 10 mg/kg	16 weeks		Symptoms resolved
Bodilsen et al. [66]	Case report	Joints	Oral Co-trimoxazole	Oral co-trimoxazole TMP-SMX 800/160 mg twice daily	12 weeks		Wound healed without a scar and no history of relapse
Behera et al. [67]	Case report	Liver, spleen, lungs and joints	Oral Co-trimoxazole (MIC < 2/38 microg/mL)	Oral co-trimoxazole (TMP/SMX) 1 double strength tablet every 12 h	24 weeks		Symptoms resolved
Saravu et al. [68]	Case report	Case 1—brain, lung, liver, spleen	Oral doxycycline and oral Co-trimoxazole	Oral co-trimoxazole 320 mg/1600 mg, twice a day and doxycycline 100 mg every 12 h	24 weeks		Patient improved
		Case 2—spinal cord	Oral doxycycline and oral Co-trimoxazole	Oral co-trimoxazole 320 mg/1600 mg, twice a day and doxycycline 100 mg every 12 h	24 weeks		Patient improved partially

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ISSN: 1476-0711

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