Antibiotic prophylaxis for melioidosis in patients receiving hemodialysis in the tropics? One size does not fit all

Chau, Ken W.T., Smith, Simon, Kang, Katherine, Dheda, Shyam, and Hanson, Joshua (2018) Antibiotic prophylaxis for melioidosis in patients receiving hemodialysis in the tropics? One size does not fit all. American Journal of Tropical Medicine and Hygiene, 99 (3). pp. 597-600.

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Abstract

Melioidosis has a high case fatality rate and is more common in patients with chronic kidney disease. Some authors recommended trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis for all hemodialysis (HD) patients during the wet season in melioidosis-endemic regions. Historical data were reviewed to determine if TMP/SMX prophylaxis was warranted in the HD population of Far North Queensland, Australia. Between 1997 and 2017, there were 242 culture-confirmed cases of melioidosis in the region, three (1.2%) occurred in HD patients; all survived without intensive care support. During the study period, there were 843 HD patients in the region with 3,024 cumulative patient years of risk. Even assuming 100% efficacy, it would have been necessary to prescribe TMP/SMX for 1,008 patient years to prevent one case of melioidosis. Given the significant additional cost and potentially life-threatening side effects of TMP/SMX therapy, clinicians should review the local epidemiology of melioidosis before the implementation of universal TMP/SMX prophylaxis in their HD population.

Item ID: 55706
Item Type: Article (Research - C1)
ISSN: 1476-1645
Copyright Information: Copyright © 2018 by The American Society of Tropical Medicine and Hygiene.
Date Deposited: 26 Sep 2018 08:52
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1108 Medical Microbiology > 110801 Medical Bacteriology @ 50%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 100%
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