Monitoring
All patients on melioidosis therapy require regular follow-up during intensive and eradication therapy and thereafter, for at least 1 year post completion of therapy and longer in complex cases. Fevers may take over a week of intensive therapy to settle and even while on ceftazidime or meropenem treatment further sites of infection may become evident, such as septic arthritis, osteomyelitis, or internal abscesses. Pneumonia may initially progress, requiring a period of intensive care therapy. Measures of inflammatory response such as white blood cell count and C-reactive protein are useful indicators of improvement. A full blood count and renal and liver function tests are required while on trimethoprim/sulfamethoxazole.
Recrudescence of disease after initial response can occur while on therapy and usually reflects undrained internal foci of infection, inadequate duration of intensive intravenous therapy, or the patient not completing eradication therapy. Recurrent melioidosis following therapy can be either relapse (with molecular typing showing the same strain) or re-infection with a new strain.
Relapse correlates with duration of and compliance with the eradication therapy as well as severity of initial infection and usually occurs within 2 years of initial diagnosis. Duration of the intensive phase has been considered also critical, with longer periods of intravenous therapy correlated with relapse rates now <5%.[85]
Secondary antibiotic resistance is rare in Burkholderia pseudomallei, but should be assessed by antimicrobial susceptibility testing of all recrudescent or relapse strains.
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