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Melioidosis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesMelioidosisRACP Adult Medicine

A 55-year-old man from Northern Territory presents during the wet season with septic shock, bilateral pneumonia, and liver abscesses. Blood cultures grow Burkholderia pseudomallei. He has type 2 diabetes and heavy alcohol use. What is the recommended intensive phase antibiotic?

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Correct answer: A — IV meropenem 1 g 8-hourly for ≥14 days

Melioidosis (caused by B. pseudomallei, endemic in tropical northern Australia) requires a two-phase treatment approach. The intensive phase uses IV meropenem (or ceftazidime) for a minimum of 10–14 days (often extended to 4–6 weeks for severe disease). This is followed by prolonged eradication therapy with oral TMP-SMX (± doxycycline) for at least 3–6 months to prevent relapse. Risk factors include diabetes, heavy alcohol use, CKD, and immunosuppression.

Reference: eTG – 2025 – Antibiotic Guidelines; Darwin Melioidosis Guidelines – 2024