Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei Infection, 2010

Rebecca Lipsitz

, Susan Garges, Rosemarie Aurigemma, Prasith Baccam, David D. Blaney, Allen C. Cheng, Bart J. Currie, David Dance, Jay E. Gee, Joseph Larsen, Direk Limmathurotsakul, Meredith G. Morrow, Robert Norton, Elizabeth O’Mara, Sharon J. Peacock, Nicki Pesik, L. Paige Rogers, Herbert P. Schweizer, Ivo Steinmetz, Gladys Tan, Patrick Tan, W. Joost Wiersinga, Vanaporn Wuthiekanun, and Theresa L. Smith

Author affiliations: Author affiliations: Department of Health and Human Services, Washington, DC, USA (R. Lipsitz, J. Larsen, L.P. Rogers); National Institutes of Health, Bethesda, Maryland, USA (S. Garges, R. Aurigemma); IEM, Research Triangle Park, North Carolina, USA (P. Baccam); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D. Blaney, J.E. Gee, M. Morrow, E. O’Mara, N. Pesik, T. Smith); Royal Darwin Hospital, Casuarina, Northern Territory, Australia (A. Cheng, B.J. Currie); Menzies School of Health Research, Casuarina, (A. Cheng, B.J. Currie); Monash University Melbourne, Victoria, Australia (A. Cheng); Alfred Hospital, Melbourne (A. Cheng); Mahosot Hospital, Vientiane, Laos (D. Dance); University of Oxford, Oxford, UK (D. Dance); Mahidol University, Bangkok, Thailand (D. Limmathurotsakul, S.J. Peacock, V. Wuthiekanun); Townsville Hospital, Townsville, Queensland, Australia (R. Norton); University of Cambridge, Cambridge, UK (S. Peacock); Colorado State University, Fort Collins, Colorado, USA (H.P. Schweizer); University of Greifswald, Greifswald, Germany (I. Steinmetz); DSO National Laboratories, Singapore (G. Tan); Genome Institute of Singapore, Singapore (P. Tan); Duke–National University of Singapore Graduate Medical School, Singapore (P. Tan); and Academic Medical Center, Amsterdam, the Netherlands (J. Wiersinga)

Abstract

The US Public Health Emergency Medical Countermeasures Enterprise convened subject matter experts at the 2010 HHS Burkholderia Workshop to develop consensus recommendations for postexposure prophylaxis against and treatment for Burkholderia pseudomallei and B. mallei infections, which cause melioidosis and glanders, respectively. Drugs recommended by consensus of the participants are ceftazidime or meropenem for initial intensive therapy, and trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid for eradication therapy. For postexposure prophylaxis, recommended drugs are trimethoprim/sulfamethoxazole or co-amoxiclav. To improve the timely diagnosis of melioidosis and glanders, further development and wide distribution of rapid diagnostic assays were also recommended. Standardized animal models and B. pseudomallei strains are needed for further development of therapeutic options. Training for laboratory technicians and physicians would facilitate better diagnosis and treatment options.

As of 2010, the literature did not contain broadly developed consensus recommendations for melioidosis therapy and postexposure prophylaxis (PEP) that could inform US government preparedness activities. The Public Health Emergency Medical Countermeasures Enterprise convened the 2010 HHS Burkholderia Workshop to generate expert consensus recommendations for use during a public health emergency. This enterprise is a coordinated interagency effort that is responsible for defining and prioritizing requirements for public health emergency medical countermeasures, focusing research, development, and procurement activities on the identified requirements, and establishing deployment and use strategies for medical countermeasures in the Strategic National Stockpile.
A comprehensive literature review revealed consensus recommendations for other biological threat pathogens that served as a template for recommendations made during the workshop. Use of these Burkholderia recommendations will improve US government efforts in preparing for public health emergencies as well as assist clinicians in case management of melioidosis. This workshop hosted internationally recognized leaders in the field of Burkholderia spp. research and diagnostics and eminent clinicians whose expertise in the treatment for endemic melioidosis is unparalleled. The results of the workshop were achieved through structured dialogue and question-and-answer sessions. The workshop recommendations stem largely from clinical experience with melioidosis. However, the workshop participants noted that although Burkholderia mallei is sensitive to gentamicin and macrolides (in contrast to B. pseudomallei), the recommended treatment regimens and PEP for melioidosis were considered to also be appropriate for glanders. The US government will consider these expert recommendations when developing its formal policies.