Treatment of Childhood Brucellosis: A Systematic Review

• Published in: The Pediatric infectious disease journal Vol. 43; no. 9; pp. 857 - 866
• Main Authors: Lanza Galvão, Endi, Miranda Souza, Kathiaja, Gonçalves de Freitas, Marina, Souza, Marina Rocha Fonseca, Gonçalves, Moisés Willian Aparecido, Cota, Gláucia, Silva, Sarah Nascimento
• Format: Journal Article
• Language: English
• Published: United States 01-09-2024
• Subjects: Aminoglycosides - therapeutic use; Anti-Bacterial Agents - therapeutic use; Brucellosis - drug therapy; Child; Child, Preschool; Drug Therapy, Combination; Humans; Rifampin - therapeutic use; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
• ISSN: 0891-3668; 1532-0987; 1532-0987
• DOI: 10.1097/INF.0000000000004389

Proper treatment for brucellosis is crucial to eradicate the infection and prevent complications, but there is a notable gap in evidence for pediatric treatment. This study aims to address this gap by reviewing current literature, analyzing the efficacy and safety of brucellosis treatment in children, and identifying areas that require further investigation.
A systematic review, following preferred reporting items for systematic reviews and meta-analyses and Cochrane Handbook guidelines, assessed antimicrobial regimens' efficacy and safety for treating human brucellosis in children. Original human studies with clinical outcomes after drug therapy intervention for children up to 10 years were included. Searches were conducted in Medline, Embase, Cochrane Library and LILACS databases for studies indexed until March 6, 2023. Study selection, data extraction, and bias risk assessment were performed by pairs of reviewers. The quality assessment used Joanna Briggs Institute tools and grading of recommendations assessment, development and evaluation system. Data were analyzed using R software.
A total of 1773 records were reviewed, yielding 11 eligible studies encompassing 1156 children. All included studies presented an observational design. The most reported treatment approaches included sulfamethoxazole-trimethoprim with rifampicin or aminoglycosides, with summarized failure rates of 2% (95% confidence interval: 0.0-0.49) and 13% (95% confidence interval: 0.06-0.29), respectively (very low certainty of evidence). Adverse events and time to defervescence were not reported.
Sulfamethoxazole-trimethoprim + rifampicin were the most prescribed antibiotics for brucellosis for pediatrics. The study highlights the need for more research with robust designs, and emphasizes uncertainty regarding the efficacy of antimicrobial regimens, emphasizing the importance of further investigations to guide specific treatment protocols for this population.