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 2 Summary of the RCTs using co-trimoxazole in the eradication phase

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

Name	Study type	Drugs	Sample size	Open or blind	Dose	Duration of eradication phase	Relapse rate		Mortality rate
Name	Study type	Drugs	Sample size	Open or blind	Dose	Duration of eradication phase	Culture positive	Clinical relapse	Mortality rate
Chaowagul et al. [34]	RCT	1.Co-trimoxazole, doxycycline, chloramphenicol	91	Open	Co- trimoxazole (8mg TMP and 40mg SMX/kg/ daily; max 160mg TMP and 800mg SMX/twice daily	12 weeks	11.8%		14%
Chaowagul et al. [34]	RCT	2.Co-trimoxazole (TMP/SMX), doxycycline	89	Open			5.4%		11%
Rajchanuvong et al. [35]		1.Chloramphenicol, doxycycline, Co-trimoxazole	52	Open	Co-trimoxazole (10mg TMP + 50mg SMX/kg/day in 2 divided doses)	20 weeks	10%		1.92%
Rajchanuvong et al. [35]		2. Doxycycline	49	Open		20 weeks	36%		8.16%
Anunnatsiri et al. [36]	RCT	Co-trimoxazole	12 week – 322	Open	< 40 kg, the dose used was 160/800 mg of TMP/SMX twice daily; for a body weight of 40–60 kg, the dose was 240/1200 mg of TMP/SMX twice daily; and for a body weight > 60 kg, the dose was 320/1600 mg of TMP/SMX twice daily	12 weeks	2%		0.3%
Anunnatsiri et al. [36]	RCT	Co-trimoxazole	20 weeks	Open		20 weeks	1%		3%
Chetchotisakd et al. [37]	RCT	1.Co-trimoxazole, placebo	311	Double blind	TMP-SMX (80 mg TMP and 400 mg SMX) tablets were prescribed using a weight-based dose, bodyweight less than 40 kg or eGFR 15–29 mL/min, 160 mg TMP and 800 mg SMX twice daily; bodyweight of 40 kg to 60 kg, 240 mg TMP and 1200 mg SMX twice daily; and bodyweight greater than 60 kg, 320 mg TMP and 1600 mg SMX twice daily	20 weeks	16%	3%	3%
Chetchotisakd et al. [37]	RCT	2.Co-trimoxazole, Doxycycline	315	Double blind		20 weeks	21%	8%	1%
Chetchotisakd et al. [4]	RCT	1. Ciprofloxacin and azithromycin	32	Open	Co- trimoxazole (10mg TMP + 50mg SMX/kg/day in 2 divided doses)	12 weeks	22%		3.12%
Chetchotisakd et al. [4]	RCT	2. Co-trimoxazole and doxycycline	33	Open		20 weeks	3%		0%
Chaowagal et al. [38]	RCT	1. Co-trimoxazole, doxycycline, chloramphenicol	91	Open	Co- trimoxazole (8mg TMP and 40mg SMX/kg/ daily; max 160mg TMP and 800mg SMX/twice daily	12 weeks	2%	5.9%	4.4%
Chaowagal et al. [38]		2.Doxycycline	89	Open		12 weeks	5.6%	13%	6.74%
Chaowagul et al. [34]	RCT	1.Co-trimoxazole, doxycycline, chloramphenicol	91	Open	Co- trimoxazole (8mg TMP and 40mg SMX/kg/ daily; max 160mg TMP and 800mg SMX/twice daily	12 weeks	11.8%		14%
Chaowagul et al. [34]	RCT	2.Co-trimoxazole (TMP/SMX), doxycycline	89	Open			5.4%		11%
Rajchanuvong et al.[35]		1.Chloramphenicol, doxycycline, Co-trimoxazole	52	Open	Co-trimoxazole (10mg TMP + 50mg SMX/kg/day in 2 divided doses)	20 weeks	10%		1.92%
Rajchanuvong et al.[35]		2. Doxycycline	49	Open		20 weeks	36%		8.16%
Anunnatsiri et al. [36]	RCT	Co-trimoxazole	12 week – 322	Open	< 40 kg, the dose used was 160/800 mg of TMP/SMX twice daily; for a body weight of 40–60 kg, the dose was 240/1200 mg of TMP/SMX twice daily; and for a body weight > 60 kg, the dose was 320/1600 mg of TMP/SMX twice daily	12 weeks	2%		0.3%
Anunnatsiri et al. [36]	RCT	Co-trimoxazole	20 weeks	Open		20 weeks	1%		3%
Chetchotisakd et al. [37]	RCT	1.Co-trimoxazole, placebo	311	Double blind	TMP-SMX (80 mg TMP and 400 mg SMX) tablets were prescribed using a weight-based dose, bodyweight less than 40 kg or eGFR 15–29 mL/min, 160 mg TMP and 800 mg SMX twice daily; bodyweight of 40 kg to 60 kg, 240 mg TMP and 1200 mg SMX twice daily; and bodyweight greater than 60 kg, 320 mg TMP and 1600 mg SMX twice daily	20 weeks	16%	3%	3%
Chetchotisakd et al. [37]	RCT	2.Co-trimoxazole, Doxycycline	315	Double blind		20 weeks	21%	8%	1%
Chetchotisakd et al. [4]	RCT	1. Ciprofloxacin and azithromycin	32	Open	Co- trimoxazole (10mg TMP + 50mg SMX/kg/day in 2 divided doses)	12 weeks	22%		3.12%
Chetchotisakd et al. [4]	RCT	2. Co-trimoxazole and doxycycline	33	Open		20 weeks	3%		0%
Chaowagal et al. [38]	RCT	1. Co-trimoxazole, doxycycline, chloramphenicol	91	Open	Co- trimoxazole (8mg TMP and 40mg SMX/kg/ daily; max 160mg TMP and 800mg SMX/twice daily	12 weeks	2%	5.9%	4.4%
Chaowagal et al. [38]		2.Doxycycline	89	Open		12 weeks	5.6%	13%	6.74%

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