Wipada ChaowagulAndrew J.H. SimpsonYupin SuputtamongkolMichael D. SmithBrian J. AngusNicholas J. WhiteSappasitthiprasong HospitalMahidol UniversityCentre for Tropical MedicineJohn Radcliffe HospitalMusgrove Park Hospital2018-09-072018-09-071999-01-01Clinical Infectious Diseases. Vol.29, No.2 (1999), 375-380105848382-s2.0-0032769578https://repository.li.mahidol.ac.th/handle/20.500.14594/25768A prospective, open, randomized, comparative treatment trial was conducted to compare the therapeutic efficacy of the conventional four-drug combination (chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline) with that of doxycycline alone in oral maintenance treatment of melioidosis. Adult Thai patients with culture-confirmed melioidosis were randomized to receive treatment with either regimen for a minimum of 12 weeks, usually following intravenous treatment of severe disease. The main outcome measure was culture-confirmed relapse. One hundred sixteen patients were enrolled; 109 had culture-confirmed melioidosis, and 87 were considered evaluable (43 had received doxycycline). Culture-confirmed relapse occurred in one patient randomized to the conventional regimen and in 11 (25.6%) randomized to the doxycycline regimen (P= .009), and treatment failed for 8 (18.2%) versus 20 (46.5%), respectively (P = .009). Adverse effects occurred in 26% of patients overall. Doxycycline alone cannot be recommended for a first-line regimen of oral maintenance treatment of melioidosis.Mahidol UniversityMedicineArticleSCOPUS10.1086/520218