{ "schema_version": 1, "kind": "condition", "id": "brucellosis", "name": "Brucellosis", "category": "infectious", "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", "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", "verified_date": "2026-08", "treatments": [ { "id": 316, "generic": "Doxycycline", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg BID with food & full glass of water", "adult_duration": "6 weeks", "dose_source": "Egyptian MOH Zoonotic 2021; StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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\".", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FARCODOXIN 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXY M.R.100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANUDOXY 100MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXYDOX 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 23.0, "pack_count": 10, "unit_price": 2.3, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXYMYCIN 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 30.0, "pack_count": 10, "unit_price": 3.0, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TABOCINE 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 46.0, "pack_count": 10, "unit_price": 4.6, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIBRAMYCIN 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 65.0, "pack_count": 10, "unit_price": 6.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "brucellosis" }, { "id": 317, "generic": "Rifampicin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 300.0, "adult_dose": "600-900 mg once daily in morning on empty stomach", "adult_duration": "6 weeks", "dose_source": "Egyptian MOH Zoonotic 2021", "rationale": "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." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 20.0, "peds_max_mg": 900.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Once daily for 6 weeks combined with Co-trimoxazole or Aminoglycoside", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 200, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 400, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 600, "capped": false }, { "weight_kg": 40, "low_mg": 600, "high_mg": 800, "capped": false } ], "brands": [ { "trade_name": "RIFAMPIN 300MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB CAPS", "price_egp": 8.0, "pack_count": 10, "unit_price": 0.8, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFABIOTIC 300 MG 8 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 8.0, "pack_count": 8, "unit_price": 1.0, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAMPICIN 300MG 8 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 9.5, "pack_count": 8, "unit_price": 1.19, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAMPIN 300MG 8 CAPS (MISR)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 9.5, "pack_count": 8, "unit_price": 1.19, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIMACTANE 300MG 8 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 10.1, "pack_count": 8, "unit_price": 1.26, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAMPIN 300MG 10 CAPS. (DEBEIKY)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY", "price_egp": 38.5, "pack_count": 10, "unit_price": 3.85, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFACTINE 300 MG 8 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 31.0, "pack_count": 8, "unit_price": 3.88, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAMOX 100MG/5ML 30GM SUSP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAM 100MG/5ML 60ML SUSP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 7.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "brucellosis" }, { "id": 320, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Brucellosis - disease-level clinical article (brucellosis-clinical.txt)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "brucellosis" }, { "id": 318, "generic": "Gentamicin", "line": 2, "is_adjunct": false, "form": "injection", "strength_mg": 80.0, "adult_dose": "5 mg/kg IV/IM once daily for the first 7-14 days, given WITH doxycycline - never on its own", "adult_duration": "7-14 days", "dose_source": "Egyptian MOH Zoonotic 2021; StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management", "rationale": "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\"." ], "peds_mgkg_low": 5.0, "peds_mgkg_high": 7.5, "peds_max_mg": 240.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 50, "high_mg": 75, "capped": false }, { "weight_kg": 20, "low_mg": 100, "high_mg": 150, "capped": false }, { "weight_kg": 30, "low_mg": 150, "high_mg": 225, "capped": false }, { "weight_kg": 40, "low_mg": 200, "high_mg": 240, "capped": true } ], "brands": [ { "trade_name": "REFOBACIN 80MG 3 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE > MERCK KGAA F.R.GERMANY", "price_egp": 9.0, "pack_count": null, "unit_price": null, "strength_mg": 80.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GENTAMICIN-ALEX 80MG/2ML 3 AMP. I.M/I.V INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 52.5, "pack_count": null, "unit_price": null, "strength_mg": 80.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPIGENT 80MG/2ML I.M./I.V. 3 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 54.0, "pack_count": null, "unit_price": null, "strength_mg": 80.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GARAMYCIN 80MG/2ML 3 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 60.0, "pack_count": null, "unit_price": null, "strength_mg": 80.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "brucellosis" }, { "id": 319, "generic": "Sulfamethoxazole + trimethoprim", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 800.0, "adult_dose": "One double-strength tablet (sulfamethoxazole 800 mg + trimethoprim 160 mg) every 12 hours, given with rifampicin", "adult_duration": "6 weeks, alongside the rifampicin", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph); StatPearls: Brucellosis (NCBI Bookshelf NBK441831), Treatment / Management", "rationale": "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." ], "peds_mgkg_low": 6.0, "peds_mgkg_high": 12.0, "peds_max_mg": 320.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "2 months and over", "age_min_months": 2, "age_max_months": 216, "dose_text": "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." } ], "peds_doses": [ { "weight_kg": 10, "low_mg": 60, "high_mg": 120, "capped": false }, { "weight_kg": 20, "low_mg": 120, "high_mg": 240, "capped": false }, { "weight_kg": 30, "low_mg": 180, "high_mg": 320, "capped": true }, { "weight_kg": 40, "low_mg": 240, "high_mg": 320, "capped": true } ], "brands": [ { "trade_name": "CO-TRIMOXAZOLE 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 5.0, "pack_count": 20, "unit_price": 0.25, "strength_mg": null, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "COTRIL 400/80MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 80.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SEPTAZOLE FORTE 800/160MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 56.0, "pack_count": 20, "unit_price": 2.8, "strength_mg": 160.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SEPTRIN D.S 10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE > ASPEN PHARMA TRADING LIMITED", "price_egp": 28.0, "pack_count": 10, "unit_price": 2.8, "strength_mg": null, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SEPTAZOLE 400/80MG 20*10 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 340.0, "pack_count": 10, "unit_price": 34.0, "strength_mg": 80.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SUTRIM 400/80MG 20*10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 340.0, "pack_count": 10, "unit_price": 34.0, "strength_mg": 80.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CO-TRIMOXAZOLE 200/40MG SUSP. 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 6.0, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "SUTRIM 200/40MG SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 18.5, "pack_count": null, "unit_price": null, "strength_mg": 40.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "brucellosis" }, { "id": 321, "generic": "Streptomycin", "line": 2, "is_adjunct": false, "form": "injection", "strength_mg": 1000.0, "adult_dose": "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", "adult_duration": "14 to 21 days", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "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" ], "peds_mgkg_low": 20.0, "peds_mgkg_high": 40.0, "peds_max_mg": 2000.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 200, "high_mg": 400, "capped": false }, { "weight_kg": 20, "low_mg": 400, "high_mg": 800, "capped": false }, { "weight_kg": 30, "low_mg": 600, "high_mg": 1200, "capped": false }, { "weight_kg": 40, "low_mg": 800, "high_mg": 1600, "capped": false } ], "brands": [ { "trade_name": "STREPTOMYCIN SULPHATE-CID 1GM I.M.VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STREPTOMYCIN-MISR 1GM VIAL USP 24", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STREPTOMYCIN-EL NILE 1GM VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 11.25, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "brucellosis" } ] }