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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 2

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

Drug Patient characteristics Recommended dosage/frequency
Trimethoprim/sulfamethoxazole† Adult, >60 kg 160 mg/800 mg tablets: 2 tablets every 12 h
Adult, 40–60 kg 80 mg/400 mg tablets: 3 tablets every 12 h
Adult, <40 kg 160 mg/800 mg tablets: 1 tablet every 12 h OR
80 mg/400 mg tablets: 2 tablets every 12 h
Child
 8 mg/40 mg/kg; maximum dose 320 mg/1,600 mg every 12 h
OR
Amoxicillin/clavulanic acid (co-amoxiclav) Adult, >60 kg 500 mg/125 mg tablets: 3 tablets every 8 h‡
Adult, <60 kg 500 mg/125 mg tablets: 2 tablets every 8 h‡
Child 20 mg/5 mg/kg every 8 h; maximum dose 1,000 mg/250 mg every 8 h

*Recommended duration of therapy is a minimum of 12 weeks.
†If the organism is susceptible and the patient does not have a documented allergy to it, oral trimethoprim/sulfamethoxazole is the agent of first choice. If the organism is resistant to trimethoprim/sulfamethoxazole or the patient is intolerant, the second-line choice is co-amoxiclav. Co-amoxiclav is available in different ratios and formulations, depending on the source country. Co-amoxiclav at a ratio of 4:1 is preferred to ensure there is sufficient clavulanate (47). Preparations of co-amoxiclav are available in the United States, with ratios of amoxicillin to clavulanic acid ranging from  2:1 to 16:1, as follows: 22:1 (Augmentin 250 mg), 4:1 (Augmentin 125 mg and 250 mg suspension, Augmentin 125 mg and 250 mg chewable tablet, Augmentin 500 mg.), 7:1 (Augmentin 200 mg and 400 mg suspension, Augmentin 400 mg chewable tablet, Augmentin 875 mg oral tablet), 14:1 (Augmentin ES-600, Amoclan 600 mg suspension) and 16:1 (Augmentin XR).
‡Weight-based dosage based on 20 mg/5 mg/kg/dose.

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