The diagnosis of melioidosis cannot be made definitively on clinical evaluation alone because melioidosis can cause a wide variety of non-unique clinical manifestations. Clinicians are challenged to determine clinically whether a person has melioidosis or another bacterial infection requiring a different class of antimicrobial drugs for treatment. Ambiguous clinical signs and symptoms and misdiagnosis could lead to ineffective empiric treatment because of the resistance of B. pseudomallei to many standard antimicrobials. After the sentinel cases are identified and B. pseudomallei is detected in clinical specimens, many persons with systemic disease would probably be treated empirically because of limited diagnostic capabilities.

 

Antimicrobial Use and Drug Efficacy Studies

Treatment for melioidosis consists of an initial intravenous intensive phase (Table 1) that lasts for 10–14 days (or longer when clinically indicated) and an oral eradication phase (Table 2). The oral antimicrobial eradication phase substantially lowers the risk for relapse that can occur with intravenous antimicrobial drugs only. In addition to the availability of appropriate antimicrobials, access to intensive care facilities has been cited as a critical contributing factor to successful outcomes. The lack of widespread intensive care facilities in Thailand is thought to be a substantial factor contributing to a mortality rate that is on average 30% higher than that in Australia…