# Brucellosis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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 ## Treatment metadata - Doxycycline — 100 mg — oral.solid - Rifampicin — 300 mg — oral.solid - Referral & safety-netting (no drug therapy) - Gentamicin — 80 mg — injection - Sulfamethoxazole + trimethoprim — 800 mg — oral.solid - Streptomycin — 1000 mg — injection ## Complete treatment card ```text BRUCELLOSIS 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 Review status: REVIEWED against 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 (2026-08) 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 Source StatPearls "Brucellosis" - disease-level clinical article Status traced to the source above !! 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 [1 of 2 - GIVE ALL TOGETHER] Adult 100 mg BID with food & full glass of water x 6 weeks Peds 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". 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. Caution 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. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) 2. RIFAMPICIN [2 of 2 - GIVE ALL TOGETHER] Adult 600-900 mg once daily in morning on empty stomach x 6 weeks Peds 15-20 mg/kg/day [child max 900 mg] (Once daily for 6 weeks combined with Co-trimoxazole or Aminoglycoside) 3kg -> 45-60 mg/day 4kg -> 60-80 mg/day 5kg -> 75-100 mg/day 6kg -> 90-120 mg/day 7kg -> 105-140 mg/day 8kg -> 120-160 mg/day 9kg -> 135-180 mg/day 10kg -> 150-200 mg/day 11kg -> 165-220 mg/day 12kg -> 180-240 mg/day 13kg -> 195-260 mg/day 14kg -> 210-280 mg/day 15kg -> 225-300 mg/day 16kg -> 240-320 mg/day 17kg -> 255-340 mg/day 18kg -> 270-360 mg/day 19kg -> 285-380 mg/day 20kg -> 300-400 mg/day 21kg -> 315-420 mg/day 22kg -> 330-440 mg/day 23kg -> 345-460 mg/day 24kg -> 360-480 mg/day 25kg -> 375-500 mg/day 26kg -> 390-520 mg/day 27kg -> 405-540 mg/day 28kg -> 420-560 mg/day 29kg -> 435-580 mg/day 30kg -> 450-600 mg/day 31kg -> 465-620 mg/day 32kg -> 480-640 mg/day 33kg -> 495-660 mg/day 34kg -> 510-680 mg/day 35kg -> 525-700 mg/day 36kg -> 540-720 mg/day 37kg -> 555-740 mg/day 38kg -> 570-760 mg/day 39kg -> 585-780 mg/day 40kg -> 600-800 mg/day 41kg -> 615-820 mg/day 42kg -> 630-840 mg/day 43kg -> 645-860 mg/day 44kg -> 660-880 mg/day 45kg -> 675-900 mg/day 46kg -> 690-900 mg/day (upper capped) 47kg -> 705-900 mg/day (upper capped) 48kg -> 720-900 mg/day (upper capped) 49kg -> 735-900 mg/day (upper capped) 50kg -> 750-900 mg/day (upper capped) 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. Caution 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. Egypt RIFAMPIN 300MG 10 CAPS. ARAB CAPS 8.00 EGP (0.80/unit) RIFABIOTIC 300 MG 8 CAPS. CID 8.00 EGP (1.00/unit) RIFAMPICIN 300MG 8 CAPS. EL NASR 9.50 EGP (1.19/unit) RIFAMPIN 300MG 8 CAPS (MISR) MISR 9.50 EGP (1.19/unit) RIMACTANE 300MG 8 CAPS. NOVARTIS 10.10 EGP (1.26/unit) RIFAMPIN 300MG 10 CAPS. (DEBEIKY) DEBEIKY 38.50 EGP (3.85/unit) RIFACTINE 300 MG 8 CAPS. MUP 31.00 EGP (3.88/unit) RIFAMOX 100MG/5ML 30GM SUSP. EL NASR 4.50 EGP -> ? strength differs, ? different route - not oral solid RIFAM 100MG/5ML 60ML SUSP. PHARCO 7.00 EGP -> ? strength differs, ? different route - not oral solid 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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] Adult 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 Peds 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.) 3kg -> 60-120 mg/day 4kg -> 80-160 mg/day 5kg -> 100-200 mg/day 6kg -> 120-240 mg/day 7kg -> 140-280 mg/day 8kg -> 160-320 mg/day 9kg -> 180-360 mg/day 10kg -> 200-400 mg/day 11kg -> 220-440 mg/day 12kg -> 240-480 mg/day 13kg -> 260-520 mg/day 14kg -> 280-560 mg/day 15kg -> 300-600 mg/day 16kg -> 320-640 mg/day 17kg -> 340-680 mg/day 18kg -> 360-720 mg/day 19kg -> 380-760 mg/day 20kg -> 400-800 mg/day 21kg -> 420-840 mg/day 22kg -> 440-880 mg/day 23kg -> 460-920 mg/day 24kg -> 480-960 mg/day 25kg -> 500-1000 mg/day 26kg -> 520-1040 mg/day 27kg -> 540-1080 mg/day 28kg -> 560-1120 mg/day 29kg -> 580-1160 mg/day 30kg -> 600-1200 mg/day 31kg -> 620-1240 mg/day 32kg -> 640-1280 mg/day 33kg -> 660-1320 mg/day 34kg -> 680-1360 mg/day 35kg -> 700-1400 mg/day 36kg -> 720-1440 mg/day 37kg -> 740-1480 mg/day 38kg -> 760-1520 mg/day 39kg -> 780-1560 mg/day 40kg -> 800-1600 mg/day 41kg -> 820-1640 mg/day 42kg -> 840-1680 mg/day 43kg -> 860-1720 mg/day 44kg -> 880-1760 mg/day 45kg -> 900-1800 mg/day 46kg -> 920-1840 mg/day 47kg -> 940-1880 mg/day 48kg -> 960-1920 mg/day 49kg -> 980-1960 mg/day 50kg -> 1000-2000 mg/day Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Aminoglycoside combination partner with doxycycline for initial treatment of acute brucellosis. Caution Hypersensitivity to streptomycin, other aminoglycosides, or any component of the formulation Auditory ototoxicity, vestibular ototoxicity Azotemia, nephrotoxicity Egypt STREPTOMYCIN SULPHATE-CID 1GM I.M.VIAL CID 5.00 EGP STREPTOMYCIN-MISR 1GM VIAL USP 24 MISR 5.00 EGP STREPTOMYCIN-EL NILE 1GM VIAL EL NILE. 11.25 EGP SEVERE DISEASE - ADD TO DOXYCYCLINE 5. GENTAMICIN [2nd line] Adult 5 mg/kg IV/IM once daily for the first 7-14 days, given WITH doxycycline - never on its own x 7-14 days Peds 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.) 3kg -> 15-22.5 mg/day 4kg -> 20-30 mg/day 5kg -> 25-37.5 mg/day 6kg -> 30-45 mg/day 7kg -> 35-52.5 mg/day 8kg -> 40-60 mg/day 9kg -> 45-67.5 mg/day 10kg -> 50-75 mg/day 11kg -> 55-82.5 mg/day 12kg -> 60-90 mg/day 13kg -> 65-97.5 mg/day 14kg -> 70-105 mg/day 15kg -> 75-112.5 mg/day 16kg -> 80-120 mg/day 17kg -> 85-127.5 mg/day 18kg -> 90-135 mg/day 19kg -> 95-142.5 mg/day 20kg -> 100-150 mg/day 21kg -> 105-157.5 mg/day 22kg -> 110-165 mg/day 23kg -> 115-172.5 mg/day 24kg -> 120-180 mg/day 25kg -> 125-187.5 mg/day 26kg -> 130-195 mg/day 27kg -> 135-202.5 mg/day 28kg -> 140-210 mg/day 29kg -> 145-217.5 mg/day 30kg -> 150-225 mg/day 31kg -> 155-232.5 mg/day 32kg -> 160-240 mg/day 33kg -> 165-240 mg/day (upper capped) 34kg -> 170-240 mg/day (upper capped) 35kg -> 175-240 mg/day (upper capped) 36kg -> 180-240 mg/day (upper capped) 37kg -> 185-240 mg/day (upper capped) 38kg -> 190-240 mg/day (upper capped) 39kg -> 195-240 mg/day (upper capped) 40kg -> 200-240 mg/day (upper capped) 41kg -> 205-240 mg/day (upper capped) 42kg -> 210-240 mg/day (upper capped) 43kg -> 215-240 mg/day (upper capped) 44kg -> 220-240 mg/day (upper capped) 45kg -> 225-240 mg/day (upper capped) 46kg -> 230-240 mg/day (upper capped) 47kg -> 235-240 mg/day (upper capped) 48kg -> 240 mg/day (capped) 49kg -> 240 mg/day (capped) 50kg -> 240 mg/day (capped) 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. Caution 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". Egypt REFOBACIN 80MG 3 AMP. GLAXO SMITHKL... 9.00 EGP GENTAMICIN-ALEX 80MG/2ML 3 AMP. I.M/I.V INJ. ALEXANDRIA 52.50 EGP EPIGENT 80MG/2ML I.M./I.V. 3 AMPS. EIPICO 54.00 EGP GARAMYCIN 80MG/2ML 3 AMPS. MEMPHIS 60.00 EGP CHILD UNDER 8 6. SULFAMETHOXAZOLE + TRIMETHOPRIM [2nd line] Adult One double-strength tablet (sulfamethoxazole 800 mg + trimethoprim 160 mg) every 12 hours, given with rifampicin x 6 weeks, alongside the rifampicin Peds 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.) 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. 3kg -> 18-36 mg/day 4kg -> 24-48 mg/day 5kg -> 30-60 mg/day 6kg -> 36-72 mg/day 7kg -> 42-84 mg/day 8kg -> 48-96 mg/day 9kg -> 54-108 mg/day 10kg -> 60-120 mg/day 11kg -> 66-132 mg/day 12kg -> 72-144 mg/day 13kg -> 78-156 mg/day 14kg -> 84-168 mg/day 15kg -> 90-180 mg/day 16kg -> 96-192 mg/day 17kg -> 102-204 mg/day 18kg -> 108-216 mg/day 19kg -> 114-228 mg/day 20kg -> 120-240 mg/day 21kg -> 126-252 mg/day 22kg -> 132-264 mg/day 23kg -> 138-276 mg/day 24kg -> 144-288 mg/day 25kg -> 150-300 mg/day 26kg -> 156-312 mg/day 27kg -> 162-320 mg/day (upper capped) 28kg -> 168-320 mg/day (upper capped) 29kg -> 174-320 mg/day (upper capped) 30kg -> 180-320 mg/day (upper capped) 31kg -> 186-320 mg/day (upper capped) 32kg -> 192-320 mg/day (upper capped) 33kg -> 198-320 mg/day (upper capped) 34kg -> 204-320 mg/day (upper capped) 35kg -> 210-320 mg/day (upper capped) 36kg -> 216-320 mg/day (upper capped) 37kg -> 222-320 mg/day (upper capped) 38kg -> 228-320 mg/day (upper capped) 39kg -> 234-320 mg/day (upper capped) 40kg -> 240-320 mg/day (upper capped) 41kg -> 246-320 mg/day (upper capped) 42kg -> 252-320 mg/day (upper capped) 43kg -> 258-320 mg/day (upper capped) 44kg -> 264-320 mg/day (upper capped) 45kg -> 270-320 mg/day (upper capped) 46kg -> 276-320 mg/day (upper capped) 47kg -> 282-320 mg/day (upper capped) 48kg -> 288-320 mg/day (upper capped) 49kg -> 294-320 mg/day (upper capped) 50kg -> 300-320 mg/day (upper capped) 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. Caution 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. Egypt CO-TRIMOXAZOLE 20 TABS. MUP 5.00 EGP (0.25/unit) -> ? strength differs COTRIL 400/80MG 20 TAB. EL NASR 38.00 EGP (1.90/unit) -> ? strength differs SEPTAZOLE FORTE 800/160MG 20 TABS. ALEXANDRIA 56.00 EGP (2.80/unit) -> ? strength differs SEPTRIN D.S 10 TABS. GLAXO SMITHKL... 28.00 EGP (2.80/unit) -> ? strength differs SEPTAZOLE 400/80MG 20*10 TABS. ALEXANDRIA 340.00 EGP (34.00/unit) -> ? strength differs SUTRIM 400/80MG 20*10 TAB. MEMPHIS 340.00 EGP (34.00/unit) -> ? strength differs CO-TRIMOXAZOLE 200/40MG SUSP. 120ML MUP 6.00 EGP -> ? strength differs, ? different route - not oral solid SUTRIM 200/40MG SUSP. 100ML MEMPHIS 18.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)