Ariza J, Gudiol F, Pallarés R, Rufí G, Fernández-Viladrich P
Antimicrob Agents Chemother. 1985 Oct;28(4):548-51. doi: 10.1128/AAC.28.4.548.
In an attempt to compare the efficacy of rifampin-doxycycline with tetracycline-streptomycin for the treatment of human brucellosis, we administered both combinations for a 30-day period, similar to the period recommended by the World Health Organization in a prospective, randomized trial. Forty-six patients were included in the final study (36 men and 10 women); 41 had blood cultures positive for Brucella melitensis. The 28 patients in group A received tetracycline hydrochloride at doses of 0.5 g every 6 h or doxycycline at 100 mg every 12 h for 30 days plus 1 g of streptomycin a day for 21 days. The 18 patients in group B received rifampin at 15 mg/kg per day in a single morning dose plus 100 mg of doxycycline every 12 h for 30 days. For patients with focal disease from both groups, therapy was prolonged to 45 days. All patients underwent rigorous clinical and bacteriological long-term follow-up. There were no therapeutic failures in either group, and the defervescence period was similar for both groups (3.1 days for group A, 2.6 days for group B). Two patients (7.1%) from group A had relapses, as did seven (38.8%) from group B (P = 0.024), and blood cultures again became positive for B. melitensis in all of them. In both groups treatment was generally well tolerated. The results strongly suggest that the rifampin-doxycycline combination is a less efficacious mode of therapy for brucellosis to prevent relapses than is the classical tetracycline-streptomycin combination when both are administered for 30 days. A more prolonged period of administration of the rifampin-doxycycline combination may be required to obtain the same low relapse rate as that achieved with the classical tetracycline-streptomycin treatment.
为比较利福平 - 多西环素与四环素 - 链霉素治疗人类布鲁氏菌病的疗效，我们在一项前瞻性随机试验中，按照世界卫生组织推荐的疗程，给予这两种联合用药方案各30天。最终研究纳入了46例患者（36例男性和10例女性）；41例血培养布鲁氏菌羊种阳性。A组的28例患者接受盐酸四环素，每6小时0.5克或多西环素，每12小时100毫克，共30天，加链霉素每天1克，共21天。B组的18例患者接受利福平，每天15毫克/千克，晨起单次给药，加多西环素每12小时100毫克，共30天。两组有局灶性病变的患者，治疗延长至45天。所有患者均接受了严格的临床和细菌学长期随访。两组均无治疗失败病例，两组的退热期相似（A组3.1天，B组2.6天）。A组有2例患者（7.1%）复发，B组有7例（38.8%）复发（P = 0.024），所有复发患者血培养布鲁氏菌羊种再次呈阳性。两组治疗总体耐受性良好。结果强烈表明，当两种方案均给药30天时，与经典的四环素 - 链霉素联合用药相比，利福平 - 多西环素联合用药预防布鲁氏菌病复发的疗效较差。可能需要延长利福平 - 多西环素联合用药的疗程，以获得与经典四环素 - 链霉素治疗相同的低复发率。
