Dawaa Reference

infectious

Brucellosis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Egyptian MOH Zoonotic 2021 · WHO Brucellosis Guidelines 2006 · Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph) · Egyptian MOH Zoonotic 2021; StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management · Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph); StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management

Verified against5 documents
  • Egyptian MOH Zoonotic 2021
  • Egyptian MOH Zoonotic 2021; StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management
  • Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph); StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management
  • Brucellosis - disease-level clinical article (brucellosis-clinical.txt)
  • Egyptian National Drug Formulary - Antimicrobial 2023

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Presentation includes headache, cyclical fever, migratory joint and muscle pain, fatigue, poor appetite, malaise, weakness, sweating, and GI upset [fatigue · fever · headache · joint pain · malaise · migratory pain · muscle pain · poor appetite · sweating]
  • Respiratory complaints such as cough, breathlessness, and pleuritic pain can occur, though the chest x-ray is usually normal [breathlessness · chest pain · cough]
  • Foul, mold- or wet-hay-smelling sweat has been described in some patients
  • Death occurs in about 2% of cases
  • A dietary history of eating food shipped from an endemic region matters when the patient lives elsewhere

Signs — what you find (7)

  • Exam is usually normal, though lymph node, spleen, or liver enlargement can be found
  • Epididymo-orchitis presents with a tender, swollen, red scrotum
  • A new or changing heart murmur, or a pericardial rub, may signal cardiac involvement [friction rub · heart murmur]
  • Endocarditis is rare but is the leading cause of death from brucellosis
  • Meningitis shows neck stiffness with positive Kernig and Brudzinski signs [neck rigidity on testing · neck stiffness]
  • A brain abscess or raised intracranial pressure can cause papilledema, palsy of a cranial nerve, and focal deficits on neurologic exam [abscess · paralysis]
  • Skin findings can include a maculopapular rash, erythema nodosum, abscesses, and panniculitis [rash · redness]

Tests (10)

  • Diagnosis usually needs culture and serology, since symptoms and signs are nonspecific
  • CBC typically shows low neutrophils and anemia, with thrombocytopenia sometimes seen
  • Inflammatory markers such as CRP, ESR, LDH, and alkaline phosphatase can be elevated
  • Blood cultures in tryptose medium can take a week or more to turn positive, given how slowly Brucella grows
  • Marrow cultures are more often positive than blood cultures, since the reticuloendothelial system harbors a high Brucella burden
  • Agglutination testing is the standard serologic method in endemic regions
  • A titer above 1:160 with a fitting clinical picture suggests infection; above 1:320 is considered more specific
  • PCR targeting the BCSP31 gene or the 16S-23S rRNA operon allows rapid detection
  • The Pedro Pons sign, erosion of the upper front edge of a lumbar vertebra with osteophytes, is linked to Brucella spondylodiscitis
  • Bone marrow or percutaneous liver biopsy may be needed to secure a diagnosis in some patients

If not this — what else fits (5)

  • Infectious mononucleosis from EBV and infective endocarditis are considered
  • Influenza, leptospirosis, and malaria are also on the differential
  • Mechanical back pain and meningitis are further considerations
  • Mycoplasma pneumonia, viral hepatitis, and enteric fever should be considered
  • Acute epididymitis and a urinary tract infection round out the differential

SourceStatPearls "Brucellosis" - disease-level clinical article

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them.

!! the regimen: Doxycycline + Rifampicin

Rx: Main treatment | Severe disease - add to doxycycline | Child under 8

MAIN TREATMENT - choose one

1

DOXYCYCLINE

Regimen: brucella-dual

1 of 2 - GIVE ALL TOGETHER

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg BID with food & full glass of water x 6 weeks

Paediatric dose

Contraindicated in children under 8 years due to tooth staining. Doxycycline 100 mg Capsules SmPC section 4.2 says "Doxycycline should not be used in children aged younger than 8 years due to the risk of teeth discolouration", and the Egyptian National Drug Formulary - Antimicrobial 2023 doxycycline monograph adds "Use of doxycycline in children <8 years should be reserved for severe, potentially life-threatening infections, or when better alternatives are unavailable".

Dose source

Egyptian MOH Zoonotic 2021; StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management

Why

Tetracycline antibiotic that forms the backbone of brucellosis treatment; used alone it relapses in a large proportion of patients, which is why it is always combined with a second agent such as rifampicin or gentamicin, as the cautions describe.

Cautions
  • Monotherapy relapses. StatPearls puts the relapse rate of doxycycline alone at approximately 40%, which is why rifampicin 600-900 mg/day is added. Never treat brucellosis with one drug.
  • CONTRAINDICATED in pregnancy and breastfeeding - refer for a rifampicin-based regimen.
  • Must be combined with Rifampicin or Gentamicin to prevent relapse.
  • Take upright with full glass of water to avoid esophageal ulcer.
  • Photosensitivity is a risk, so advise sun protection.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)
2

RIFAMPICIN

Regimen: brucella-dual

2 of 2 - GIVE ALL TOGETHER

Strength300 mg

Formoral.solid

Adult dose and duration

600-900 mg once daily in morning on empty stomach x 6 weeks

Paediatric dose

15-20 mg/kg/day [child max 900 mg]

(Once daily for 6 weeks combined with Co-trimoxazole or Aminoglycoside)

Dose by weight
3kg45-60 mg/day
4kg60-80 mg/day
5kg75-100 mg/day
6kg90-120 mg/day
7kg105-140 mg/day
8kg120-160 mg/day
9kg135-180 mg/day
10kg150-200 mg/day
11kg165-220 mg/day
12kg180-240 mg/day
13kg195-260 mg/day
14kg210-280 mg/day
15kg225-300 mg/day
16kg240-320 mg/day
17kg255-340 mg/day
18kg270-360 mg/day
19kg285-380 mg/day
20kg300-400 mg/day
21kg315-420 mg/day
22kg330-440 mg/day
23kg345-460 mg/day
24kg360-480 mg/day
25kg375-500 mg/day
26kg390-520 mg/day
27kg405-540 mg/day
28kg420-560 mg/day
29kg435-580 mg/day
30kg450-600 mg/day
31kg465-620 mg/day
32kg480-640 mg/day
33kg495-660 mg/day
34kg510-680 mg/day
35kg525-700 mg/day
36kg540-720 mg/day
37kg555-740 mg/day
38kg570-760 mg/day
39kg585-780 mg/day
40kg600-800 mg/day
41kg615-820 mg/day
42kg630-840 mg/day
43kg645-860 mg/day
44kg660-880 mg/day
45kg675-900 mg/day
46kg690-900 mg/day (upper capped)
47kg705-900 mg/day (upper capped)
48kg720-900 mg/day (upper capped)
49kg735-900 mg/day (upper capped)
50kg750-900 mg/day (upper capped)
Dose source

Egyptian MOH Zoonotic 2021

Why

Antibiotic with strong intracellular penetration against Brucella, combined with doxycycline as the second agent needed to prevent relapse; also a potent enzyme inducer, so drug interactions need checking.

Cautions
  • Potent CYP3A4 inducer - reduces oral contraceptive & statin levels.
  • Monitor LFTs baseline and at 2-4 weeks.
  • Rifampicin causes orange/red discoloration of urine, tears, and sweat.
Egyptian brands
Egyptian brandManufacturerIndicative price
RIFAMPIN 300MG 10 CAPS.ARAB CAPS8.00 EGP (0.80/unit)
RIFABIOTIC 300 MG 8 CAPS.CID8.00 EGP (1.00/unit)
RIFAMPICIN 300MG 8 CAPS.EL NASR9.50 EGP (1.19/unit)
RIFAMPIN 300MG 8 CAPS (MISR)MISR9.50 EGP (1.19/unit)
RIMACTANE 300MG 8 CAPS.NOVARTIS10.10 EGP (1.26/unit)
RIFAMPIN 300MG 10 CAPS. (DEBEIKY)DEBEIKY38.50 EGP (3.85/unit)
RIFACTINE 300 MG 8 CAPS.MUP31.00 EGP (3.88/unit)
RIFAMOX 100MG/5ML 30GM SUSP.? strength differs? different route - not oral solidEL NASR4.50 EGP
RIFAM 100MG/5ML 60ML SUSP.? strength differs? different route - not oral solidPHARCO7.00 EGP
3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Brucellosis - disease-level clinical article (brucellosis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - A new or changing heart murmur or pericardial rub signals endocarditis, the most common cause of death from brucellosis.
4

STREPTOMYCIN

2nd line

Strength1000 mg

Forminjection

Adult dose and duration

IM, IV: 1 g once daily in combination with doxycycline. Duration depends on extent of disease; streptomycin is usually given for the first 14 to 21 days of therapy, followed by doxycycline monotherapy x 14 to 21 days

Paediatric dose

20-40 mg/kg/day [child max 2000 mg]

(Children (general dosing): IM: 20–40 mg/kg daily in divided doses every 6–12 hours; maximum dose: 1,000 mg/dose; maximum daily dose: 2,000 mg/day.)

Dose by weight
3kg60-120 mg/day
4kg80-160 mg/day
5kg100-200 mg/day
6kg120-240 mg/day
7kg140-280 mg/day
8kg160-320 mg/day
9kg180-360 mg/day
10kg200-400 mg/day
11kg220-440 mg/day
12kg240-480 mg/day
13kg260-520 mg/day
14kg280-560 mg/day
15kg300-600 mg/day
16kg320-640 mg/day
17kg340-680 mg/day
18kg360-720 mg/day
19kg380-760 mg/day
20kg400-800 mg/day
21kg420-840 mg/day
22kg440-880 mg/day
23kg460-920 mg/day
24kg480-960 mg/day
25kg500-1000 mg/day
26kg520-1040 mg/day
27kg540-1080 mg/day
28kg560-1120 mg/day
29kg580-1160 mg/day
30kg600-1200 mg/day
31kg620-1240 mg/day
32kg640-1280 mg/day
33kg660-1320 mg/day
34kg680-1360 mg/day
35kg700-1400 mg/day
36kg720-1440 mg/day
37kg740-1480 mg/day
38kg760-1520 mg/day
39kg780-1560 mg/day
40kg800-1600 mg/day
41kg820-1640 mg/day
42kg840-1680 mg/day
43kg860-1720 mg/day
44kg880-1760 mg/day
45kg900-1800 mg/day
46kg920-1840 mg/day
47kg940-1880 mg/day
48kg960-1920 mg/day
49kg980-1960 mg/day
50kg1000-2000 mg/day
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Aminoglycoside combination partner with doxycycline for initial treatment of acute brucellosis.

Cautions
  • Hypersensitivity to streptomycin, other aminoglycosides, or any component of the formulation
  • Auditory ototoxicity, vestibular ototoxicity
  • Azotemia, nephrotoxicity
Egyptian brands
Egyptian brandManufacturerIndicative price
STREPTOMYCIN SULPHATE-CID 1GM I.M.VIALCID5.00 EGP
STREPTOMYCIN-MISR 1GM VIAL USP 24MISR5.00 EGP
STREPTOMYCIN-EL NILE 1GM VIALEL NILE.11.25 EGP

SEVERE DISEASE - ADD TO DOXYCYCLINE

5

GENTAMICIN

Severe disease - add to doxycycline

2nd line

Strength80 mg

Forminjection

Adult dose and duration

5 mg/kg IV/IM once daily for the first 7-14 days, given WITH doxycycline - never on its own x 7-14 days

Paediatric dose

5-7.5 mg/kg/day [child max 240 mg]

(5-7.5 mg/kg IV/IM once daily for 7-14 days, as the aminoglycoside half of a regimen. In a child who cannot have doxycycline the sourced regimen is co-trimoxazole with rifampicin for 4-6 weeks; StatPearls does not pair gentamicin with co-trimoxazole.)

Dose by weight
3kg15-22.5 mg/day
4kg20-30 mg/day
5kg25-37.5 mg/day
6kg30-45 mg/day
7kg35-52.5 mg/day
8kg40-60 mg/day
9kg45-67.5 mg/day
10kg50-75 mg/day
11kg55-82.5 mg/day
12kg60-90 mg/day
13kg65-97.5 mg/day
14kg70-105 mg/day
15kg75-112.5 mg/day
16kg80-120 mg/day
17kg85-127.5 mg/day
18kg90-135 mg/day
19kg95-142.5 mg/day
20kg100-150 mg/day
21kg105-157.5 mg/day
22kg110-165 mg/day
23kg115-172.5 mg/day
24kg120-180 mg/day
25kg125-187.5 mg/day
26kg130-195 mg/day
27kg135-202.5 mg/day
28kg140-210 mg/day
29kg145-217.5 mg/day
30kg150-225 mg/day
31kg155-232.5 mg/day
32kg160-240 mg/day
33kg165-240 mg/day (upper capped)
34kg170-240 mg/day (upper capped)
35kg175-240 mg/day (upper capped)
36kg180-240 mg/day (upper capped)
37kg185-240 mg/day (upper capped)
38kg190-240 mg/day (upper capped)
39kg195-240 mg/day (upper capped)
40kg200-240 mg/day (upper capped)
41kg205-240 mg/day (upper capped)
42kg210-240 mg/day (upper capped)
43kg215-240 mg/day (upper capped)
44kg220-240 mg/day (upper capped)
45kg225-240 mg/day (upper capped)
46kg230-240 mg/day (upper capped)
47kg235-240 mg/day (upper capped)
48kg240 mg/day (capped)
49kg240 mg/day (capped)
50kg240 mg/day (capped)
Dose source

Egyptian MOH Zoonotic 2021; StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management

Why

Aminoglycoside used as the initial combination partner with doxycycline in severe or acute brucellosis, in place of rifampicin; effective only as part of that combination, never as monotherapy.

Cautions
  • Half a regimen, not an alternative to one. StatPearls has doxycycline given for brucellosis only alongside a second drug - streptomycin, rifampicin, gentamicin, or sulfamethoxazole/trimethoprim. Gentamicin alone does not treat brucellosis.
  • Ototoxicity and nephrotoxicity risk - monitor renal function & levels. Gentamicin 40mg/ml Solution for Injection or Infusion SmPC (eMC product 2394) says, in section 4.4, "Due to the potential for ototoxicity and nephrotoxicity, monitoring of vestibule, cochlea and renal function is recommended before, during and shortly after treatment", and in section 4.2, "Serum concentration monitoring of gentamicin is recommended, especially in elderly, in newborns and in patients with impaired renal function".
  • Gentamicin is the Egyptian MOH alternative to Streptomycin for acute severe brucellosis.
  • Avoid concurrent use with other nephrotoxic drugs. Gentamicin 40mg/ml Solution for Injection or Infusion SmPC section 4.5 (eMC product 2394) says "Concurrent administration of gentamicin and other potentially ototoxic or nephrotoxic drugs should be avoided. Potent diuretics such as etacrynic acid and furosemide are expected to enhance the risk of ototoxicity whilst amphotericin B, cisplatin and ciclosporin are potential enhancers of nephrotoxicity".
Egyptian brands
Egyptian brandManufacturerIndicative price
REFOBACIN 80MG 3 AMP.GLAXO SMITHKLINE > MERCK KGAA F.R.GERMANY9.00 EGP
GENTAMICIN-ALEX 80MG/2ML 3 AMP. I.M/I.V INJ.ALEXANDRIA52.50 EGP
EPIGENT 80MG/2ML I.M./I.V. 3 AMPS.EIPICO54.00 EGP
GARAMYCIN 80MG/2ML 3 AMPS.MEMPHIS60.00 EGP

CHILD UNDER 8

6

SULFAMETHOXAZOLE + TRIMETHOPRIM

Child under 8

2nd line

Strength800 mg

Formoral.solid

Adult dose and duration

One double-strength tablet (sulfamethoxazole 800 mg + trimethoprim 160 mg) every 12 hours, given with rifampicin x 6 weeks, alongside the rifampicin

Paediatric dose

6-12 mg/kg/day [child max 320 mg]

(Doses are the trimethoprim component: 6 to 12 mg TMP/kg/day in divided doses every 12 hours, maximum single dose 160 mg TMP. Give with rifampicin for 4 to 6 weeks. Not under 2 months.)

Dose by age
2 months and over:6 to 12 mg trimethoprim/kg/day in divided doses every 12 hours, maximum single dose 160 mg trimethoprim. Give with rifampicin for 4 to 6 weeks. Not under 2 months.
Dose by weight
3kg18-36 mg/day
4kg24-48 mg/day
5kg30-60 mg/day
6kg36-72 mg/day
7kg42-84 mg/day
8kg48-96 mg/day
9kg54-108 mg/day
10kg60-120 mg/day
11kg66-132 mg/day
12kg72-144 mg/day
13kg78-156 mg/day
14kg84-168 mg/day
15kg90-180 mg/day
16kg96-192 mg/day
17kg102-204 mg/day
18kg108-216 mg/day
19kg114-228 mg/day
20kg120-240 mg/day
21kg126-252 mg/day
22kg132-264 mg/day
23kg138-276 mg/day
24kg144-288 mg/day
25kg150-300 mg/day
26kg156-312 mg/day
27kg162-320 mg/day (upper capped)
28kg168-320 mg/day (upper capped)
29kg174-320 mg/day (upper capped)
30kg180-320 mg/day (upper capped)
31kg186-320 mg/day (upper capped)
32kg192-320 mg/day (upper capped)
33kg198-320 mg/day (upper capped)
34kg204-320 mg/day (upper capped)
35kg210-320 mg/day (upper capped)
36kg216-320 mg/day (upper capped)
37kg222-320 mg/day (upper capped)
38kg228-320 mg/day (upper capped)
39kg234-320 mg/day (upper capped)
40kg240-320 mg/day (upper capped)
41kg246-320 mg/day (upper capped)
42kg252-320 mg/day (upper capped)
43kg258-320 mg/day (upper capped)
44kg264-320 mg/day (upper capped)
45kg270-320 mg/day (upper capped)
46kg276-320 mg/day (upper capped)
47kg282-320 mg/day (upper capped)
48kg288-320 mg/day (upper capped)
49kg294-320 mg/day (upper capped)
50kg300-320 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph); StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management

Why

The condition currently offers nothing at all for a child under 8, because doxycycline stains developing teeth and the row says so. Co-trimoxazole with rifampicin is the recognised substitute, and both drugs are Egyptian Essential Medicine List entries.

Cautions
  • Give with rifampicin, not alone. This is the regimen for children and in pregnancy, where doxycycline is barred. StatPearls offers children trimethoprim-sulfamethoxazole with rifampicin over 4 to 6 weeks, precisely because a child should not be treated with doxycycline.
  • This is the regimen for a child under 8 years, or an adult who cannot take doxycycline. It is not an addition to the doxycycline and rifampicin - it replaces the doxycycline.
  • CONTRAINDICATED in pregnancy and breastfeeding, and in infants under 2 months. A pregnant woman with brucellosis is a referral - the formulary lists pregnancy and breastfeeding among the contraindications.
  • Never give it alone. Single-drug treatment of brucellosis relapses.
  • Contraindicated in marked hepatic damage and in folate-deficiency megaloblastic anaemia; reduce the dose to about half if creatinine clearance is 15 to 30 mL/min.
  • Rifampicin turns urine, tears and sweat orange and wrecks the oral contraceptive - the same warnings as on the rifampicin row apply.
Egyptian brands
Egyptian brandManufacturerIndicative price
CO-TRIMOXAZOLE 20 TABS.? strength differsMUP5.00 EGP (0.25/unit)
COTRIL 400/80MG 20 TAB.? strength differsEL NASR38.00 EGP (1.90/unit)
SEPTAZOLE FORTE 800/160MG 20 TABS.? strength differsALEXANDRIA56.00 EGP (2.80/unit)
SEPTRIN D.S 10 TABS.? strength differsGLAXO SMITHKLINE > ASPEN PHARMA TRADING LIMITED28.00 EGP (2.80/unit)
SEPTAZOLE 400/80MG 20*10 TABS.? strength differsALEXANDRIA340.00 EGP (34.00/unit)
SUTRIM 400/80MG 20*10 TAB.? strength differsMEMPHIS340.00 EGP (34.00/unit)
CO-TRIMOXAZOLE 200/40MG SUSP. 120ML? strength differs? different route - not oral solidMUP6.00 EGP
SUTRIM 200/40MG SUSP. 100ML? strength differs? different route - not oral solidMEMPHIS18.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.