The Assessment of the Clinical Effect of the Drug Compatibility and Course of Treatment to the Brucellar Spondylitis

Xin-Ming Yang, Wei Shi, Xian-Yong Meng, Ying Zhang, Ya-Kun Du, Lei Zhang, Yao-Yi Wang

Department of Neurology, The Children’s Hospital of Hebei Province, Shijiazhuang, China.
Department of Neurosurgery, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Orthopaedics, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China.
Department of Paediatrics, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China.

DOI: 10.4236/ss.2013.41017                

Abstract

Objective: To evaluate five drug treatment regimens in the treatment of Brucella spondylitis. Methods: Patients with clinical symptoms compatible and diagnostic test consistent with Brucella spondylitis were randomly assigned to five drug treatment regimens. Results: Combination therapy with doxycycline, rifampin and sulfamethoxazole for 56 consecutive days showed the highest cure rate of 20% after a single course and of 85% after a double course with affectivity rates of 55% and 95%. Cure rate and affectivity rate was significant better (P < 0.05) than for patients receiving doxycycline, rifampin and streptomycin for the same period and regimens containing doxycycline were significant better than regimens without this drug. Conclusion: Combination therapy of doxycycline, rifampin and sulfamethoxazole for 8 weeks using one or two full courses should be recommended for Brucella spondylitis.

Keywords

Brucellosis; Spondylitis; Clinic Effect; Course of Treatment; Drug Compatibility

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. Turgut, A. T. Turgut and U. Kosar, “Spinal Brucellosis: Turkish Experience Based on 452 Cases Published during the Last Century,” Acta Neurochirgica, Vol. 148, No. 10, 2006, pp. 1033-1044. doi:10.1007/s00701-006-0877-3
[2]	A. Raptopoulou, A. H. Karantanas, K. Poumboulidis, G. Grollios, M. Raptopoulou-Gigi and A. Garyfallos, “Brucellar Spondylodiscitis: Noncontiguous Multifocal Involvement of the Cervical, Thoracic, and Lumbar Spine,” Clinical Imaging, Vol. 30, No. 3, 2006, pp. 214-217. doi:10.1016/j.clinimag. 2005.10.006
[3]	M. H. Yilmaz, B. Mete, F. Kantarci, R. Ozaras, H. Ozer, A. Mert, I. Mihmanli, R. Ozturk and K. Kanbergoglu, “Tuberculous, Brucellar and Pyogenic Spondylitis: Comparison of Magnetic Resonance Imaging Findings and Assessment of Its Value,” South Medical Journal, Vol. 100, No. 6, 2007, pp. 613-614. doi:10.1097/SMJ.0b013e3180600eaa
[4]	J. S. G. del Pozo, M. V. Soto and J. Solera, “Vertebral Osteomyelitis: Long-Term Disability Assessment and Prognostic Factors,” Journal of Infection, Vol. 54, No. 2, 2007, pp. 129-134. doi:10.1016/j.jinf.2006.01.013
[5]	P. Atonis, M. Tzermiadianos, A. Gikas, P. Papagelopoulos and A. Hadjipavlou, “Surgical Treatment of Spinal Brucellosis,” Clinical Orthopaedics & Related Research, Vol. 444, 2006, pp. 66-72. doi:10.1097/01.blo.0000203455.59393.9a
[6]	J. S. G. del. Pozo, M. V. Soto, M. Lizan-Garcia, E. Martinez-Alfaro, J. C. Segura-Luque and J. Solera-Santos, “Incidence of Infectious Spondylitis in the Province of Albacete (Spain),” Enfermedades Infecciosas y Microbiología Clínica, Vol. 23, No. 9, 2005, pp. 545-550. doi:10.1157/13080265
[7]	E. T. Tali, “Spinal Infections,” European Journal of Radiology, Vol. 50, No. 2, 2004, pp. 120-133. doi:10.1016/j.ejrad.2003.10.022
[8]	Y. A. Gokhale, A. G. Ambardekar, A. Bhasin, M. Patil, A. Tillu and J. Kamath, “Brucella Spondylitis and Sacroiliitis in the General Population in Mumbai,” Journal of the Association of Physicians of India, Vol. 51, 2003, pp. 659-666.
[9]	X.-M. Yang, W. Shi and Y.-K. Du, “The Clinical Characteristics and Surgical Treatment of Brucellar Spondylitis,” Chinese Journal of Orthopedics, Vol. 28, 2008, pp. 35-40.
[10]	X.-M. Yang, W. Shi and Y.-K. Du, “Image Manifestations and Surgical Treatment of Spondylitis Caused by Brucells Infection,” Chinese Journal of Zoonoses, Vol. 23, 2007, pp. 1055-1058.
[11]	X.-M. Yang, W. Shi and Y.-K. Du, “Investigation on the Curative of Brucellar Spondylitis,” Chinese Journal of Epidemiology, Vol. 27, 2008, pp. 699-703.
[12]	J. M. C. Romero, J. L. R. Salado and F. G. de la Llana, “Differences between Tuberculous Spondylitis and Brucellar Spondylitis,” Anales de Medicina Interna, Vol. 18, No. 6, 2001, pp. 309-311.
[13]	D. Ozol, A. Koktener and M. E. Uyar, “Active Pulmonary Tuberculosis with Vertebra and Rib Involvement: Case Report,” South Medical Journal, Vol. 99, No. 2, 2006, pp. 171-173. doi:10.1097/01.smj.0000198642.28149.94
[14]	G. Aydin, A. Tosun, I. Keles, E. Ayaslioglu, O. Tosun and S. Orkun, “Brucellar Spondylodiscitis: A Case Report,” International Journal of Clinical Practice, Vol. 60, No. 11, 2006, pp. 1502-1505. doi:10.1111/j.1742-1241.2005.00656.x
[15]	K. Z. Yuksel, M. Senoglu, M. Yuksel and M. Gul, “Brucellar Spondylo-Discitis with Rapidly Progressive Spinal Epidural Abscess Presenting with Sciatica,” Spinal Cord, Vol. 44, 2006, pp. 805-808. doi:10.1038/sj.sc.3101938
[16]	G. S. Guven, B. Cakir, G. Oz, M. D. Tanriover, E. Turkmen and T. Sozen, “Could Remembering the Prozone Phenomenon Shorten our Diagnostic Journey in Brucellosis?” Rheumatology International, Vol. 26, No. 10, 2006, pp. 933-935. doi:10.1007/s00296-006-0118-3
[17]	G. Pappas, S. Seitaridis, N. Akritidis and E. Tsianos, “Treatment of Brucella Spondylitis: Lessons from an Impossible Meta-Analysis and Initial Report of Efficacy of a Fluoroquinolone-Containing Regimen,” International Journal of Antimicrobial Agents, Vol. 24, No. 5, 2004, pp. 502-507. doi:10.1016/j.ijantimicag.2004.05.003
[18]	Y. Bayindir, E. Sonmez, A. Aladag and N. Buyukberber, “Comparison of Five Antimicrobial Regimens for the Treatment of Brucellar Spondylitis: A Prospective, Randomized Study,” Journal of Chemotherapy, Vol. 15, No. 5, 2003, pp. 466-471.
[19]	J. Solera, P. Geijo and J. Largo, “Arandomized, Double-Blind Study to Assess the Optimal Duration of Doxycycline Treatment for Human Brucellosis,” Clinical Infectious Diseases, Vol. 39, No. 12, 2004, pp. 1776-1782. doi:10.1086/426024
[20]	E. Alp, R. K. Koc, A. C. Durak, O. Yildiz, B. Aygen, B. Sumerkan and M. Doganay, “Doxycycline plus Streptomycin versus Ciprofloxacin plus Rifampicin in Spinal Brucellosis,” BMC Infectious Diseases, Vol. 6, 2006, pp. 72-78. doi:10.1186/1471-2334-6-72
[21]	N. G. David, C. M. Robert, M. E. George and A. S. Merle, “The Sanford Guided to Antimicrobial Therapy,” 34th Edition, Antimicrobial Theraphy, Inc., Hyde Park, 2004, pp. 48-51.
[22]	Y. Bayindir, E. Sonmez, A. Aladag and N. Buyukberber, “Comparison of Five Antimicrobial Regimens for the Treatment of Brucellar Spondylitis: A Prospective, Randomized Study,” Journal of Chemotherapy, Vol. 15, No. 15, 2003, pp. 466-471.
[23]	N. Saltoglu, Y. Tasova and A. S. Inal, “Efficacy of Rifampicin plus Doxycycline versus Rifampicin plus Quinolone in the Treatment of Brucellosis,” Saudi Medical Journal, Vol. 23, No. 8, 2002, pp. 921-924.