Persistence and relapse in brucellosis and need for improved treatment

Treatment failure and relapse are major problems in the management of brucellosis. In developing countries, treatment with the oral combination doxycycline/rifampicin is preferred because of its convenience. However, its efficacy is lower than that of the doxycycline/streptomycin regimen and is likely further reduced when compliance is poor. Alternative regimens should be investigated in well designed clinical trials to determine whether treatment can be improved. Use of DNA detection as a marker for treatment success and for the prediction of relapse requires confirmation. In the absence of simple and effective treatment regimens, patient education to promote compliance is essential.