Volume 18, Number 12—December 2012
Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei Infection, 2010
|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.