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Volume 18, Number 12—December 2012

Online Report

Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei Infection, 2010

Rebecca LipsitzComments to Author , Susan Garges, Rosemarie Aurigemma, Prasith Baccam, David D. Blaney, Allen C. Cheng, Bart J. Currie, David Dance, Jay E. Gee, Joseph Larsen, Direk Limmathurotsakul, Meredith G. Morrow, Robert Norton, Elizabeth O’Mara, Sharon J. Peacock, Nicki Pesik, L. Paige Rogers, Herbert P. Schweizer, Ivo Steinmetz, Gladys Tan, Patrick Tan, W. Joost Wiersinga, Vanaporn Wuthiekanun, and Theresa L. Smith
Author affiliations: Author affiliations: Department of Health and Human Services, Washington, DC, USA (R. Lipsitz, J. Larsen, L.P. Rogers); National Institutes of Health, Bethesda, Maryland, USA (S. Garges, R. Aurigemma); IEM, Research Triangle Park, North Carolina, USA (P. Baccam); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D. Blaney, J.E. Gee, M. Morrow, E. O’Mara, N. Pesik, T. Smith); Royal Darwin Hospital, Casuarina, Northern Territory, Australia (A. Cheng, B.J. Currie); Menzies School of Health Research, Casuarina, (A. Cheng, B.J. Currie); Monash University Melbourne, Victoria, Australia (A. Cheng); Alfred Hospital, Melbourne (A. Cheng); Mahosot Hospital, Vientiane, Laos (D. Dance); University of Oxford, Oxford, UK (D. Dance); Mahidol University, Bangkok, Thailand (D. Limmathurotsakul, S.J. Peacock, V. Wuthiekanun); Townsville Hospital, Townsville, Queensland, Australia (R. Norton); University of Cambridge, Cambridge, UK (S. Peacock); Colorado State University, Fort Collins, Colorado, USA (H.P. Schweizer); University of Greifswald, Greifswald, Germany (I. Steinmetz); DSO National Laboratories, Singapore (G. Tan); Genome Institute of Singapore, Singapore (P. Tan); Duke–National University of Singapore Graduate Medical School, Singapore (P. Tan); and Academic Medical Center, Amsterdam, the Netherlands (J. Wiersinga)

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Table 1

Workshop results for initial intensive-phase therapy for Burkholderia pseudomallei and B. mallei infections during a public health emergency, 2010*

Patient Drug Dosage/route Frequency
With no complications Ceftazidime 50 mg/kg /(up to 2 g) intravenous Every 8 h, or 6 g/d by continuous infusion after a 2-g bolus
With neuromelioidosis or persistent bacteremia or in intensive care unit Meropenem 25 mg/kg /(up to 1 g) intravenous Every 8 h

*Duration of intensive therapy is generally 10–14 d; however, >4 weeks of parenteral therapy may be necessary in cases of more severe disease, e.g., septic shock, deep seated or organ abscesses, extensive lung disease, osteomyelitis, septic arthritis, or neurologic melioidosis. Consider adding trimethoprim/sulfamethoxazole for patients with severe infection involving the brain, prostate, or other privileged site (same dosing as described for eradication therapy below. Can be administered by intravenous infusion over 30–60 min every 12 h, or nasogastric, or oral, as appropriate). If trimethoprim/sulfamethoxazole is included, continue for the entire duration of the intensive phase. Switching to meropenem is indicated if patient condition worsens while receiving ceftazidime, e.g., organ failure, development of a new focus of infection during treatment, or if repeat blood cultures remain positive. Depending on the severity of infection, the dose for patients >3 mo can be <40 mg/kg/; not to exceed 2 g/dose.

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