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Antibiotic Prophylaxis for Melioidosis in Patients Receiving Hemodialysis in the Tropics? One Size Does Not Fit All

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  • 1 Department of Medicine, Cairns Hospital, Cairns, Australia;
  • 2 James Cook University, Cairns, Australia;
  • 3 The Kirby Institute, Sydney, Australia

Melioidosis has a high case fatality rate and is more common in patients with chronic kidney disease. Some authors recommended trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis for all hemodialysis (HD) patients during the wet season in melioidosis-endemic regions. Historical data were reviewed to determine if TMP/SMX prophylaxis was warranted in the HD population of Far North Queensland, Australia. Between 1997 and 2017, there were 242 culture-confirmed cases of melioidosis in the region, three (1.2%) occurred in HD patients; all survived without intensive care support. During the study period, there were 843 HD patients in the region with 3,024 cumulative patient years of risk. Even assuming 100% efficacy, it would have been necessary to prescribe TMP/SMX for 1,008 patient years to prevent one case of melioidosis. Given the significant additional cost and potentially life-threatening side effects of TMP/SMX therapy, clinicians should review the local epidemiology of melioidosis before the implementation of universal TMP/SMX prophylaxis in their HD population.

Author Notes

Address correspondence to Josh Hanson, The Kirby Institute, University of New South Wales, Kensington, Sydney, NSW 2052, Australia. E-mail: jhanson@kirby.unsw.edu.au

Authors’ addresses: Ken W. T. Chau, Katherine Kang, and Shyam Dheda, Department of Medicine, Cairns Hospital, Cairns, Australia, E-mails: kenneth.chau@health.qld.gov.au, katherine.kang@health.qld.gov.au, and shyam.dheda@health.qld.gov.au. Simon Smith, Department of Medicine, Cairns Hospital, Cairns, Australia, and James Cook University, Cairns, Australia, E-mail: simon.smith2@health.qld.gov.au. Josh Hanson, Department of Medicine, Cairns Hospital, Cairns, Australia, and The Kirby Institute, Sydney, Australia, E-mail: jhanson@kirby.unsw.edu.au.

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