TABLE 4.

Melioidosis treatment and prophylaxis^a

Phase or adjustment	Drug and dose	Clinical manifestation(s) (duration of treatment)
Intensive	Ceftazidime, 2 g i.v. (child, 50 mg/kg up to 2 g), every 6 hours, or meropenem, 1 g i.v. (child, 25 mg/kg up to 1 g), every 8 hours (2 g for CNS infection)	Pneumonia (2–4 wks); bacteremia, no focus (2 wks); skin and soft tissue (2 wks); abscess, deep tissue (4 wks); septic arthritis, single joint (4 wks); osteomyelitis (6 wks); neurological (8 wks); mycotic aneurysm (8 wks)
Renal dose adjustment
Ceftazidime
CLCR of (ml/min):
31–50	≤60 kg, 1 g q8h; >60 kg, 2 g q8h
15–30	≤60 kg, 1 g q12h; >60 kg, 2 g q12h
<15	≤60 kg, 1 g q24h
Dialysis
HD	As for CLCR of <15, dose post-HD
CAPD	As for CLCR of <15, dose post-HD, may administer intraperitoneally with dwell time of >6 h and 25% extra dose for convenience
CRRT	2 g q12h
Meropenem
CLCR of (ml/min):
31–50	1 g q12h
15–30	1 g q12h
<15	1 g q24h
Dialysis
HD	As for CLCR of <15, dose post-HD
CAPD	As for CLCR of <15
CRRT	1 g q12h
Trimethoprim-sulfamethoxazole
CLCR of (ml/min):
31–50	≤60 kg, 240/1,200 mg every 12 hours; >60 kg, 320/1,600 mg every 12 hours
15–30	≤60 kg, 240/1,200 mg every 24 hours; >60 kg, 320/1,600 mg every 24 hours
<15	≤60 kg, 240/1,200 mg every 24 hours; >60 kg, 320/1,600 mg every 24 hours
Dialysis
HD	As for CLCR of <15, dose post-HD
CAPD	As for CLCR of <15
CRRT	As for CLCR of 15–30
Eradication	Trimethoprim-sulfamethoxazole (child, 6/30 mg/kg up to 240/1,200 mg; adult 40–60 kg, 240/1,200 mg; >60 kg, 320/1,600 mg orally, every 12 hours) and folic acid, 5 mg (child, 0.1 mg/kg up to 5 mg) orally, daily	Pneumonia (3 mo); bacteremia, no focus (3 mo); skin and soft tissue (3 mo); abscess, deep tissue (3 mo); septic arthritis, single joint (3 mo); osteomyelitis (6 mo); neurological (6 mo); endovascular (6 mo)
Prophylaxis	Trimethoprim-sulfamethoxazole (<40kg, 160/800 mg; 40–60 kg, 240/1,200 mg; >60 kg, 320/1,600 mg orally, every 12 hours) and folic acid, 5 mg (child, 0.1 mg/kg up to 5 mg) orally, daily, or doxycycline (2.5 mg/kg/dose up to 100 mg orally, every 12 hours) or amoxicillin-clavulanate (≤60 kg, 1,000/250 mg; >60 kg, 1,500/375 mg, every 8 hours)	High probability postexposure (3 wks)
	Trimethoprim-sulfamethoxazole (160/800 mg orally, daily) and folic acid (5 mg orally, daily)	Hemodialysis patients, wet season, high-incidence region (26 wks)

^aAdapted from the work of Peacock et al., Currie, Lipsitz et al., Majoni et al., Jabbar et al., and Inglis (3, 279, 539, 540, 560, 624, 625). i.v., intravenous; q8h, every 8 h; CL_CR, creatiine clearance; CNS, central nervous system; HD, hemodialysis; CAPD, continuous ambulatory peritoneal dialysis; CCRT, continuous renal replacement therapy.