Coxiella burnetii infection

Combination antibiotic regimens

There is emerging evidence to support the use of alternative combination antibiotic regimens in the treatment of chronic infection (e.g., a tetracycline plus a fluoroquinolone antibiotic, or a tetracycline plus rifampicin) as a safe alternative to doxycycline plus hydroxychloroquine, which is currently the treatment of choice.[106]van Roeden SE, Bleeker-Rovers CP, de Regt MJ, et al. Treatment of chronic Q fever: clinical efficacy and toxicity of antibiotic regimens. Clin Infect Dis. 2018 Feb 10;66(5):719-26. http://www.ncbi.nlm.nih.gov/pubmed/29040457?tool=bestpractice.com [107]Kersh GJ. Antimicrobial therapies for Q fever. Expert Rev Anti Infect Ther. 2013 Nov;11(11):1207-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608426 http://www.ncbi.nlm.nih.gov/pubmed/24073941?tool=bestpractice.com ​​ However, there are no controlled trials comparing these regimens and a lack of evidence (especially for the use of rifampicin). Despite this, alternative regimens are sometimes used in practice in patients who cannot tolerate hydroxychloroquine, or if there is treatment failure with doxycycline plus hydroxychloroquine. The use of alternative combination antibiotic regimens should be discussed with an infectious disease consultant before prescribing.