Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link

Volume 18, Number 12—December 2012

Peer Reviewed Report Available Online Only

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)

Main Article

Table 2

Workshop results for oral eradication-phase therapy for Burkholderia pseudomallei and Bmallei 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.

Main Article

References
  1. Smith  MD, Wuthiekanun  V, Walsh  AL, White  NJ. Quantitative recovery of Burkholderia pseudomallei from soil in Thailand. Trans R Soc Trop Med Hyg. 1995;89:488–90 and . DOIPubMedGoogle Scholar
  2. Millan  JM, Mayo  M, Gal  D, Janmaat  A, Currie  BJ. Clinical variation in melioidosis in pigs with clonal infection following possible environmental contamination from bore water. Vet J. 2007;174:200–2 and . DOIPubMedGoogle Scholar
  3. White  NJ. Melioidosis. Lancet. 2003;361:1715–22 and . DOIPubMedGoogle Scholar
  4. Currie  BJ, Jacups  SP, Cheng  AC, Fisher  DA, Anstey  NM, Huffam  SE, Melioidosis epidemiology and risk factors from a prospective whole-population study in northern Australia. Trop Med Int Health. 2004;9:1167–74 and . DOIPubMedGoogle Scholar
  5. Stone  R. Infectious disease. Racing to defuse a bacterial time bomb. Science. 2007;317:1022–4 and . DOIPubMedGoogle Scholar
  6. Currie  BJ, Ward  L, Cheng  AC. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis. 2010;4:e900 and . DOIPubMedGoogle Scholar
  7. Currie  BJ. Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions. Eur Respir J. 2003;22:542–50 and . DOIPubMedGoogle Scholar
  8. Puthucheary  SD, Parasakthi  N, Lee  MK. Septicaemic melioidosis: a review of 50 cases from Malaysia. Trans R Soc Trop Med Hyg. 1992;86:683–5 and . DOIPubMedGoogle Scholar
  9. Currie  BJ, Ward  L, Cheng  AC. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis. 2010;4:e900 and . DOIPubMedGoogle Scholar
  10. Currie  BJ, Fisher  DA, Howard  DM, Burrow  JN, Selvanayagam  S, Snelling  PL, The epidemiology of melioidosis in Australia and Papua New Guinea. Acta Trop. 2000;74:121–7 and . DOIPubMedGoogle Scholar
  11. Ngauy  V, Lemeshev  Y, Sadkowski  L, Crawford  G. Cutaneous melioidosis in a man who was taken as a prisoner of war by the Japanese during World War II. J Clin Microbiol. 2005;43:970–2 and . DOIPubMedGoogle Scholar
  12. Chierakul  W, Winothai  W, Wattanawaitunechai  C, Wuthiekanun  V, Rugtaengan  T, Rattanalertnavee  J, Melioidosis in 6 tsunami survivors in southern Thailand. Clin Infect Dis. 2005;41:982–90 and . DOIPubMedGoogle Scholar
  13. Limmathurotsakul  D, Jamsen  K, Arayawichanont  A, Simpson  JA, White  LJ, Lee  SJ, Defining the true sensitivity of culture for the diagnosis of melioidosis using Bayesian latent class models. PLoS ONE. 2010;5:e12485 and . DOIPubMedGoogle Scholar
  14. Bowers  JR, Engelthaler  DM, Ginther  JL, Pearson  T, Peacock  SJ, Tuanyok  A, BurkDiff: a real-time PCR allelic discrimination assay for Burkholderia pseudomallei and B. mallei. PLoS ONE. 2010;5:e15413 and . DOIPubMedGoogle Scholar
  15. Antonov  VA, Tkachenko  GA, Altukhova  VV, Savchenko  SS, Zinchenko  OV, Viktorov  DV, Molecular identification and typing of Burkholderia pseudomallei and Burkholderia mallei: when is enough enough? Trans R Soc Trop Med Hyg. 2008;102(Suppl 1):S134–9 and . DOIPubMedGoogle Scholar
  16. Ashdown  LR. An improved screening technique for isolation of Pseudomonas pseudomallei from clinical specimens. Pathology. 1979;11:293–7 and . DOIPubMedGoogle Scholar
  17. Trunck  LA, Propst  KL, Wuthiekanun  V, Tuanyok  A, Beckstrom-Sternberg  SM, Beckstrom-Sternberg  JS, Molecular basis of rare aminoglycoside susceptibility and pathogenesis of Burkholderia pseudomallei clinical isolates from Thailand. PLoS Negl Trop Dis. 2009;3:e519 and . DOIPubMedGoogle Scholar
  18. Peacock  SJ, Chieng  G, Cheng  AC, Dance  DA, Amornchai  P, Wongsuvan  G, Comparison of Ashdown's medium, Burkholderia cepacia medium, and Burkholderia pseudomallei selective agar for clinical isolation of Burkholderia pseudomallei. J Clin Microbiol. 2005;43:5359–61 and . DOIPubMedGoogle Scholar
  19. Lowe  P, Haswell  H, Lewis  K. Use of various common isolation media to evaluate the new VITEK 2 colorimetric GN card for identification of Burkholderia pseudomallei. J Clin Microbiol. 2006;44:854–6 and . DOIPubMedGoogle Scholar
  20. Amornchai  P, Chierakul  W, Wuthiekanun  V, Mahakhunkijcharoen  Y, Phetsouvanh  R, Currie  BJ, Accuracy of Burkholderia pseudomallei identification using the API 20NE system and a latex agglutination test. J Clin Microbiol. 2007;45:3774–6 and . DOIPubMedGoogle Scholar
  21. Wuthiekanun  V, Desakorn  V, Wongsuvan  G, Amornchai  P, Cheng  AC, Maharjan  B, Rapid immunofluorescence microscopy for diagnosis of melioidosis. Clin Diagn Lab Immunol. 2005;12:555–6 .PubMedGoogle Scholar
  22. Tiangpitayakorn  C, Songsivilai  S, Piyasangthong  N, Dharakul  T. Speed of detection of Burkholderia pseudomallei in blood cultures and its correlation with the clinical outcome. Am J Trop Med Hyg. 1997;57:96–9 .PubMedGoogle Scholar
  23. Wuthiekanun  V, Peacock  SJ. Management of melioidosis. Expert Rev Anti Infect Ther. 2006;4:445–55 and . DOIPubMedGoogle Scholar
  24. Chantratita  N, Rholl  DA, Sim  B, Wuthiekanun  V, Limmathurotsakul  D, Amornchai  P, Antimicrobial resistance to ceftazidime involving loss of penicillin-binding protein 3 in Burkholderia pseudomallei. Proc Natl Acad Sci U S A. 2011;108:17165–70 and . DOIPubMedGoogle Scholar
  25. Rholl  DA, Papp-Wallace  K, Tomaras  AP, Vasil  ML, Bonomo  RA, Schwezer  HP. Molecular investigations of PenA-mediated β-lactam resistance in Burkholderia pseudomallei. Front Microbiol. 2011;2:139.
  26. Chierakul  W, Anunnatsiri  S, Chaowagul  W, Peacock  SJ, Chetchotisakd  P, Day  NP. Addition of trimethoprim-sulfamethoxazole to ceftazidime during parenteral treatment of melioidosis is not associated with a long-term outcome benefit. Clin Infect Dis. 2007;45:521–3 and . DOIPubMedGoogle Scholar
  27. Suputtamongkol  Y, Rajchanuwong  A, Chaowagul  W, Dance  DA, Smith  MD, Wuthiekanun  VJ, Ceftazidime vs. amoxicillin/clavulanate in the treatment of severe melioidosis. Clin Infect Dis. 1994;19:846–53 and . DOIPubMedGoogle Scholar
  28. Karunakaran  R, Puthucheary  SD. Burkholderia pseudomallei: in vitro susceptibility to some new and old antimicrobials. Scand J Infect Dis. 2007;39:858–61 and . DOIPubMedGoogle Scholar
  29. Harris  P, Engler  C, Norton  R. Comparative in vitro susceptibility of Burkholderia pseudomallei to doripenem, ertapenem, tigecycline and moxifloxacin. Int J Antimicrob Agents. 2011;37:547–9 and . Epub 2011 Apr 9. DOIPubMedGoogle Scholar
  30. Sookpranee  T, Sookpranee  M, Mellencamp  MA, Preheim  LC. Pseudomonas pseudomallei, a common pathogen in Thailand that is resistant to the bactericidal effects of many antibiotics. Antimicrob Agents Chemother. 1991;35:484–9 and . DOIPubMedGoogle Scholar
  31. Thibault  FM, Hernandez  E, Vidal  DR, Girardet  M, Cavallo  JD. Antibiotic susceptibility of 65 isolates of Burkholderia pseudomallei and Burkholderia mallei to 35 antimicrobial agents. J Antimicrob Chemother. 2004;54:1134–8 and . Epub 2004 Oct 27. DOIPubMedGoogle Scholar
  32. Jenney  AW, Lum  G, Fisher  DA, Currie  BJ. Antibiotic susceptibility of Burkholderia pseudomallei from tropical northern Australia and implications for therapy of melioidosis. Int J Antimicrob Agents. 2001;17:109–13 and . DOIPubMedGoogle Scholar
  33. Chaowagul  W, Simpson  A, Suputtamongkol  Y, White  N. Empirical cephalosporin treatment of melioidosis. Clin Infect Dis. 1999;28:1328–30 and . DOIPubMedGoogle Scholar
  34. Dellinger  RP, Levy  MM, Carlet  JM, Bion  J, Parker  MM, Jaeschke  R, Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. [Erratum in: Crit Care Med. 2008;36:1394–6]. Crit Care Med. 2008;36:296–327 and . DOIPubMedGoogle Scholar
  35. Rajchanuvong  A, Chaowagul  W, Suputtamongkol  Y, Smith  MD, Dance  DA, White  NJ. A prospective comparison of co-amoxiclav and the combination of chloramphenicol, doxycycline, and co-trimoxazole for the oral maintenance treatment of melioidosis. Trans R Soc Trop Med Hyg. 1995;89:546–9 and . DOIPubMedGoogle Scholar
  36. Chaowagul  W, Simpson  AJ, Suputtamongkol  Y, Smith  MD, Angus  BJ, White  NJ. A comparison of chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline with doxycycline alone as maintenance therapy for melioidosis. Clin Infect Dis. 1999;29:375–80 and . DOIPubMedGoogle Scholar
  37. Cheng  AC, Currie  BJ. Melioidosis: epidemiology, pathophysiology, and management. 2007;20. [Erratum in: Clin Microbiol Rev. 2007;20:533]. Clin Microbiol Rev. 2005;18:383–416 and . DOIPubMedGoogle Scholar
  38. Currie  BJ, Fisher  DA, Howard  DM, Burrow  JN, Lo  D, Selva-Nayagam  S, Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature. Clin Infect Dis. 2000;31:981–6 and . DOIPubMedGoogle Scholar
  39. Wen  SW, Zhou  J, Yang  Q, Fraser  W, Olatunbosun  O, Walker  M. Maternal exposure to folic acid antagonists and placenta-mediated adverse pregnancy outcomes. CMAJ. 2008;179:1263–8 and . DOIPubMedGoogle Scholar
  40. Limmathurotsakul  D, Chaowagul  W, Chierakul  W, Stepniewska  K, Maharjan  B, Wuthiekanun  V, Risk factors for recurrent melioidosis in northeast Thailand. Clin Infect Dis. 2006;43:979–86 and . DOIPubMedGoogle Scholar
  41. Dance  DA, Wuthiekanun  V, Chaowagul  W, White  NJ. The activity of amoxycillin/clavulanic acid against Pseudomonas pseudomallei. J Antimicrob Chemother. 1989;24:1012–4 and . DOIPubMedGoogle Scholar
  42. Peacock  SJ, Schweizer  HP, Dance  DAB, Smith  TL, Gee  JE, Wuthiekanun  V, Management of accidental laboratory exposure to Burkholderia pseudomallei and B. mallei. Emerg Infect Dis. 2008;14:e2 and . DOIPubMedGoogle Scholar
  43. Sivalingam  SP, Sim  SH, Jasper  LC, Wang  D, Liu  Y, Ooi  EE. Pre- and post-exposure prophyalxis of experimental Burkholderia pseudomallei infection with doxycycline, amoxicillin/calvulanic acid and co-trimoxazole. J Antimicrob Chemother. 2008;61:674–8 and . DOIPubMedGoogle Scholar
  44. Feterl  M, Govan  B, Engler  C, Norton  R, Ketheesan  N. Activity of tigecycline in the treatment of acute Burkholderia pseudomallei infection in a murine model. Int J Antimicrob Agents. 2006;28:460–4 and . DOIPubMedGoogle Scholar
  45. Ulett  GC, Hirst  R, Bowden  B, Powell  K, Norton  R. A comparison of antibiotic regimens in the treatment of acute melioidosis in a mouse model. J Antimicrob Chemother. 2003;51:77–81 and . DOIPubMedGoogle Scholar
  46. Warawa  JM. Evaluation of surrogate animal models of melioidosis. Front Microbiol. 2010;1:141. Epub 2010 Dec 29.
  47. Cheng  AC, Chierakul  W, Chaowagul  W, Chetchotisakd  P, Limmathurotsakul  D, Dance  DA, Consensus guidelines for dosing of amoxicillin-clavulanate in melioidosis. Am J Trop Med Hyg. 2008;78:208–9 .PubMedGoogle Scholar

Main Article

Page created: November 06, 2012
Page updated: November 06, 2012
Page reviewed: November 06, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external