Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, University Clinic for Infectious Diseases, Skopje, Republic of North Macedonia.
Working Group On Zoonoses, International Society for Chemotherapy, Aberdeen, UK.
Infection. 2021 Oct;49(5):823-832. doi: 10.1007/s15010-021-01586-w. Epub 2021 Mar 1.
Prompt and adequate treatment of human brucellosis continues to be the most important strategy in its management, as eradication of animal brucellosis is not possible so far, and there is no adequate vaccine for humans. The goal of antibrucellar treatment is to alleviate and shorten the symptomatic period and reduce complications, relapses, and chronicity. Contemporary trends in the treatment of human brucellosis are postulated on the ability of Brucellae to persist in host macrophages through the inhibition of phagolysosome fusion and to survive for prolonged periods intracellularly without restricting basic cellular functions. As a result of this and despite satisfactory antibiotic treatment, relapses and therapeutical failures are inevitable to a certain degree. The current principles for the treatment of brucellosis advocate for a long enough treatment duration combined with antimicrobial regimens that possess activity in the intracellular acidic environment. In the future, other antimicrobial agents, immunomodulation, decrease in the intracellular acidic environment, or development of agents that would act on well-defined molecular bacterial targets, might be incorporated to improve the therapeutical effects.
及时、充分的人布鲁氏菌病治疗仍然是管理的最重要策略，因为到目前为止还不可能根除动物布鲁氏菌病，也没有针对人类的有效疫苗。抗布鲁氏菌治疗的目标是减轻和缩短症状期，减少并发症、复发和慢性化。布鲁氏菌在宿主巨噬细胞中持续存在的能力，通过抑制吞噬溶酶体融合和在细胞内长时间存活而不限制基本细胞功能，这一能力为人类布鲁氏菌病的治疗新趋势提供了依据。由于这一点，尽管抗生素治疗令人满意，但在一定程度上，复发和治疗失败是不可避免的。目前，布鲁氏菌病治疗的原则主张治疗时间足够长，并结合具有细胞内酸性环境活性的抗菌方案。未来，可能会加入其他抗菌药物、免疫调节、降低细胞内酸性环境或开发针对明确分子细菌靶点的药物，以提高治疗效果。
