Alp Emine, Koc Rahmi Kemal, Durak Ahmet Candan, Yildiz Orhan, Aygen Bilgehan, Sumerkan Bulent, Doganay Mehmet
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
BMC Infect Dis. 2006 Apr 11;6:72. doi: 10.1186/1471-2334-6-72.
The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis.
The patients diagnosed as spinal brucellosis between January 2002 to December 2004 were enrolled into the study. Patients were enrolled into the two antimicrobial therapy groups (doxycycline plus streptomycin vs. ciprofloxacin plus rifampicin) consecutively. For the cost analysis of the two regimens, only the cost of antibiotic therapy was analysed for each patient.
During the study period, 31 patients with spinal brucellosis were enrolled into the two antimicrobial therapy groups. Fifteen patients were included in doxycycline plus streptomycin group and 16 patients were included in ciprofloxacin plus rifampicin group. Forty-two levels of spinal column were involved in 31 patients. The most common affected site was lumbar spine (n = 32, 76%) and involvement level was not different in two groups. Despite the disadvantages (older age, more prevalent operation and abscess formation before the therapy) of the patients in the ciprofloxacin plus rifampicin group, the duration of the therapy (median 12 weeks in both groups) and clinical response were not different from the doxycycline plus streptomycin. The cost of ciprofloxacin plus rifampicin therapy was 1.2 fold higher than the cost of doxycycline plus streptomycin therapy.
Classical regimen (doxycycline plus streptomycin), with the appropriate duration (at least 12 weeks), is still the first line antibiotics and alternative therapies should be considered when adverse drug reactions were observed.
脊柱布鲁氏菌病的最佳治疗方案和疗程仍存在争议。本研究旨在比较环丙沙星联合利福平与多西环素联合链霉素治疗脊柱布鲁氏菌病的疗效、药物不良反应、并发症及成本。
纳入2002年1月至2004年12月期间诊断为脊柱布鲁氏菌病的患者。患者连续纳入两种抗菌治疗组（多西环素联合链霉素组与环丙沙星联合利福平组）。对于两种治疗方案的成本分析，仅分析每位患者的抗生素治疗成本。
研究期间，31例脊柱布鲁氏菌病患者被纳入两种抗菌治疗组。多西环素联合链霉素组纳入15例患者，环丙沙星联合利福平组纳入16例患者。31例患者累及42个脊柱节段。最常见的受累部位是腰椎（n = 32，76%），两组的受累节段无差异。尽管环丙沙星联合利福平组患者存在劣势（年龄较大、治疗前手术和脓肿形成更为普遍），但治疗疗程（两组中位数均为12周）和临床反应与多西环素联合链霉素组无差异。环丙沙星联合利福平治疗的成本比多西环素联合链霉素治疗高1.2倍。
经典方案（多西环素联合链霉素），在适当疗程（至少12周）时，仍是一线抗生素，当观察到药物不良反应时应考虑替代疗法。
