The treatment of<unk>  is divided into two stages, an intravenous intensive phase and an eradication phase to prevent recurrence. The choice of antibiotics depends upon the susceptibility of the bacteria to various antibiotics. B. pesudomallei is generally susceptible to ceftazidime, meropenem, imipenem, and co-amoxiclav. These drugs are designed to kill the bacteria. It is also susceptible to doxycycline, chloramphenicol, and co-trimoxazole. These drugs are designed to inhibit the growth of the bacteria. The bacteria are resistant to penicillin, ampicillin, first- and second-generation cephalosporin, gentamicin, streptomycin, tobramycin, macrolides, and polymyxins. B. pseudomallei isolates from the region of Sarawak, Malaysia are susceptible to gentamicin, though. Intensive phase Intravenous ceftazidime is the current drug of choice for treatment of acute<unk>  and should be administered for at least 10 days. Meropenem, imipenem, and the cefoperazone-sulbactam combination (Sulperazone) are also effective. Intravenous amoxicillin-clavulanate (co-amoxiclav) may be used if none of the above four drugs is available; co-amoxiclav prevents death from<unk> , as does ceftazidime. Intravenous antibiotics are given for a minimum of 10 days. The median fever clearance time in<unk>  is 9 days. Meropenem is the preferred antibiotic therapy for neurological<unk>  and those with septic shock admitted into intensive care units. Co-trimoxazole is recommended for neurological<unk> , osteomyelitis, septic arthritis, skin and gastrointestinal infection, and deeply seated abscess. For deep-seated infections such as abscesses of internal organs, osteomyelitis, septic arthritis, and neurological<unk> , the duration of antibiotics given should be longer (up to 4 to 8 weeks). The time taken for fever to be resolved can be more than 10 days in those with deep-seated infection. Resistance to ceftazidime, carbapenems, and co-amoxiclav are rare in the intensive phase, but are more prominent during eradication therapy. No differences are seen between using cefoperazone/sulbactam or ceftazidime to treat<unk> , as both show similar death rates and disease progression following treatment. For those with kidney impairment, the dosage of ceftazidime, meropenem, and co-trimoxazole should be lowered. Once the clinical condition improved, meropenem can be switched back to ceftazidime. Whether the ceftazidime or meropenem combination therapy reduces relapse rates in early phase of the therapy is unclear. Eradication phase Following the treatment of the acute disease, eradication (or maintenance) treatment with co-trimoxazole is the drug of choice and should be used for at least 3 months. For those with neurological<unk>  and osteomyelitis, drugs should be given for more than 6 months. Co-amoxiclav and doxycycline are drugs of second choice. Co-trimoxazole should not be used in those with glucose-6-phosphate dehydrogenase deficiency, as it can cause haemolytic anemia. Other side effects, such as rash, hyperkalemia, renal dysfunction, and gastrointestinal symptoms, should prompt the reduction of co-trimoxazole doses. Chloramphenicol is no longer routinely recommended for this purpose. Co-amoxiclav is an alternative for patients unable to take co-trimoxazole and doxycycline (e.g. pregnant women and children under the age of 12), but is not as effective and has higher relapse rate. Single-agent treatment with fluoroquinolone (e.g., ciprofloxacin) or doxycycline for the oral maintenance phase is ineffective. In Australia, co-trimoxazole is used in children and pregnant mothers after the first 12 weeks of pregnancy. Meanwhile, in Thailand, co-amoxiclav is the drug of choice for children and pregnant women. However, B. pseudomallei often acquires resistance when co-amoxiclav is used. Cases have also been reported where<unk>  is successfully treated with co-trimoxazole for 3 months without going through intensive therapy provided that only skin manifestations are seen without the involvement of internal organs or sepsis. Resistance to cotrimoxazole is rare in Australia. Surgery Surgical drainage is indicated for single, large abscesses in the liver, muscle, and prostate. However, for multiple abscesses in the liver, spleen, and kidney, surgical drainage may not be possible or necessary. For septic arthritis, arthrotomy washout and drainage is required. Surgical debridement may be necessary. For those with mycotic aneurysm, urgent surgery is required for prosthetic vascular grafts. Life-long therapy with co-trimoxazole may be needed for those with prosthetic vascular grafts. Other abscesses rarely need to be drained because the majority of them can resolve with antibiotic treatment. In Australia, prostate abscess may require routine imaging and drainage. Others Immunomodulating therapies such as granulocyte colony-stimulating factor, Interleukin 7, and anti-PDI (programmed cell death) could be useful in<unk>  treatment, especially for those with septic shock. This is because these drugs could help to boost the human body immune function against the bacteria.
Melioidosis
Sarcoidosis
Tuberculosis
Gamasoidosis
Amyloidosis
Miliary tuberculosis
Chronic pulmonary aspergillosis
Extrapulmonary tuberculosis