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Melioidosis Eradication Phase — SCE Infectious Diseases MCQ

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ModerateTropical & Imported InfectionsMelioidosis Eradication PhaseSCE Infectious Diseases

A 55-year-old man with recent travel to South-East Asia develops Burkholderia pseudomallei bacteraemia (melioidosis). He is started on IV Meropenem. After 14 days of IV therapy, he has clinically improved. What is the recommended eradication phase?

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Correct answer: D — Oral Co-trimoxazole (960 mg BD) for 3–6 months — to prevent relapse from intracellular persistence of B. pseudomallei

Melioidosis has a high relapse rate (up to 20%) without adequate eradication therapy, because B. pseudomallei can persist intracellularly in macrophages. The standard treatment is: intensive phase (IV Meropenem or Ceftazidime for ≥10–14 days, longer for complicated disease) followed by eradication phase (oral Co-trimoxazole 960 mg BD for 3–6 months). Doxycycline was previously used as an alternative but is now considered inferior. Co-amoxiclav is a second-line option for eradication if Co-trimoxazole is not tolerated.

Reference: WHO 2022 – Melioidosis; UKHSA 2023 – Melioidosis treatment