***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of the present prospect i ve , noncomparative , multicenter study was assess the safety and efficacy of gentamicin and doxycycline therapy for human brucellosis . In the first part of the study , a cohort of 17 patients received 100 mg of doxycycline ( or 50 mg/kg of body weight per day if the body weight was < 40 kg ) orally every 12 h for 45 days ( cohort 1 ) . In the second part of the study a subsequent cohort of 35 patients was treated with doxycycline at the same dosage for 30 days ( cohort 2 ) . All patients were treated intramuscularly with gentamicin at 240 mg ( or 5 mg/kg per day if the body weight was < 50 kg ) once daily for the first 7 days . Both cohorts showed a favorable response during therapy , and there were no therapeutic failures . Relapse was noted in 1 ( 5.9 % ; 95 % confidence interval [ 95 % CI ] , 0.15 to 28.7 % ) of the 17 patients in cohort 1 and in 8 ( 22.9 % ; 95 % CI , 10.4 to 40.1 % ) of the 35 patients in cohort 2 . Nineteen patients ( 36.5 % ; 95 % CI , 23.6 to 51.0 % ) had adverse effects , with no differences between cohorts , and no patients had a treatment-limiting adverse effect . The study indicates that the combination of doxycycline for 45 days and gentamicin for 7 days is an effective and well-tolerated therapy for human brucellosis . The relapse rates obtained with doxycycline treatment for 30 days appear to be higher than those obtained with doxycycline treatment for 45 days Background The combination therapies recommended by the World Health Organization for treatment of brucellosis are doxycycline plus rifampicin or doxycycline plus streptomycin . Although highly successful results have been obtained with these two regimens , relapse rates as high as 14.4 % . The most effective and the least toxic chemotherapy for human brucellosis is still undetermined . The aim of the present study was to investigate the efficacy , adverse effects and cost of ofloxacin plus rifampicin therapy , and doxycycline plus rifampicin therapy and evaluate in the treatment of brucellosis . Methods The open trial has been carried out prospect ively by the two medical centers from December 1999 to December 2001 in Duzce region Turkey . The diagnosis was based on the presence of signs and symptoms compatible with brucellosis including a positive agglutination titre ( ≥1/160 ) and /or a positive culture .  Doxycycline and rifampicin group consisted of 14 patients who were given doxycycline 200 mg/day plus rifampicin 600 mg/day during 45 days and this group Ofloxacin plus rifampicin group was consisted of 15 patients who were given ofloxacin  400 mg/day plus rifampicin 600 mg/day during 30 days . Results Regarding clinical and /or demographic characteristics no significant difference was found between two groups of patients that underwent two different therapeutic regimens . At the end of the therapy , two relapses were seen in both groups ( p = 0.695 ) . Although duration of therapy was two weeks shorter in group treated with rifampicin plus ofloxacin , the cure rate was similar in both groups of examinees . Fever dropped more rapidly in the group that treated with rifampicin plus ofloxacin , 74 ± 30 ( ranges 48–216 ) vs. 106 ± 26 ( ranges 48–262 ) hours ( p = 0.016 ) . Conclusions Ofloxacin plus rifampicin therapy has advantages of shorter treatment duration and provided shorter course of fever with treatment than in doxycycline plus rifampicin therapy . However ,  cost of ofloxacin plus rifampicin treatment is higher than doxycycline plus rifampicin treatment . Because of the similar effects , adverse effects and relapses rates between two regimens , we still advice doxycycline plus rifampicin for the treatment of brucellosis for countries , which have limited re sources McDevitt , D. G. (1970).Brit . J. industr . Med.,27 , 67 - 71 . Ampicillin in the treatment of brucellosis : A controlled therapeutic trial . A controlled therapeutic trial has been carried out with ampicillian in the treatment of brucellosis . Sixty-eight people , veterinary surgeons or their unqualified assistants , with serological evidence of brucella antibodies measured by the anti-human globulin ( Coombs ) test and the complement-fixation test , some of whom had symptoms consistent with a diagnosis of brucellosis , were treated in two r and om groups . One group was given ampicillin , 1 g. four times a day for 28 days ; the other took a placebo in identical capsules for the same period . The response to treatment was gauged by subjective improvement in symptoms four weeks after its completion and by serological improvement after four months . Fifty-four people completed the trial . There was no evidence that ampicillin was any more effective than the placebo in treatment , either symptomatically or serologically , but 25 % of the people in both treatment groups reported subjective symptomatic improvement . It is suggested , therefore , that subjective improvement alone is an inadequate criterion for assessing response to treatment in culturally unproven brucellosis , and that , because of this , current conventional therapies may require critical revaluation . Similarly , a subjective therapeutic response can not be relied upon for diagnostic confirmation in a patient in whom the diagnosis is uncertain A r and omized prospect i ve , pilot study was performed to compare the efficacy of oral ciprofloxacin ( 750 mg or 1000 mg bd ) with st and ard oral antimicrobial therapy ( rifampicin plus doxycycline ) in the treatment of acute infection with Brucella melitensis . All antimicrobial drugs were administered for 42 days . Although all patients responded rapidly , five of the six patients receiving ciprofloxacin  relapsed following cessation of therapy . There were no relapses among the patients who received doxycycline/rifampicin . Despite its in-vitro activity against B. melitensis ( MIC 0.5 mg/l ) , ciprofloxacin , administered twice daily , does not appear to constitute adequate therapy for acute brucellosis Effectiveness and therapeutic value of the doxycycline plus streptomycin and doxycycline plus rifampin schedules of treatment of human brucellosis have been assessed by carrying out a prospect i ve study on 111 patients r and omly distributed into two groups . Patients in group A were treated with doxycycline plus streptomycin sulphate and those in group B with doxycycline plus rifampin . The temperature of all patients reverted to normal , and 54 patients from group A ( 91.6 % ) and 45 from group B ( 86.5 % ) achieved total recovery with a single therapeutic cycle . Two therapeutic failures and 3 relapses in group A ( 8.4 % ) and 7 relapses in group B ( 13.46 % ) were observed . The tolerance to both regimens was good . Although the combination doxycycline plus rifampin offers a more convenient oral administration , in the light of these results , until more extensive research is carried out , it should be considered as an alternative rather than a first choice in the treatment of human brucellosis Background The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis . The aim of this study is to compare the efficacy , adverse drug reactions , complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis . Methods The patients diagnosed as spinal brucellosis between January 2002 to December 2004 were enrolled into the study . Patients were enrolled into the two antimicrobial therapy groups ( doxycycline plus streptomycin vs. ciprofloxacin plus rifampicin ) consecutively . For the cost analysis of the two regimens , only the cost of antibiotic therapy was analysed for each patient . Results During the study period , 31 patients with spinal brucellosis were enrolled into the two antimicrobial therapy groups . Fifteen patients were included in doxycycline plus streptomycin group and 16 patients were included in ciprofloxacin plus rifampicin group . Forty-two levels of spinal column were involved in 31 patients . The most common affected site was lumbar spine ( n = 32 , 76 % ) and involvement level was not different in two groups . Despite the disadvantages ( older age , more prevalent operation and abscess formation before the therapy ) of the patients in the ciprofloxacin plus rifampicin group , the duration of the therapy ( median 12 weeks in both groups ) and clinical response were not different from the doxycycline plus streptomycin . The cost of  ciprofloxacin plus rifampicin therapy was 1.2 fold higher than the cost of doxycycline plus streptomycin therapy . Conclusion Classical regimen ( doxycycline plus streptomycin ) , with the appropriate duration ( at least 12 weeks ) , is still the first line antibiotics and alternative therapies should be considered when adverse drug reactions were observed OBJECTIVE To compare the effectiveness of doxycycline-rifampin ( DR ) combination therapy with that of the classic doxycycline-streptomycin ( DS ) combination in patients with brucellosis . DESIGN A r and omized , double-blind study , with a mean follow-up of 15.7 months . SETTING A 1000-bed teaching hospital in Barcelona , Spain . PATIENTS Ninety-five patients ( 68 men and 27 women ; mean age , 39 years ) diagnosed with brucellosis on the basis of both clinical and serologic findings ; 81 of these patients had blood cultures positive for Brucella melitensis . INTERVENTIONS Forty-four patients received doxycycline , 100 mg every 12 hours , and rifampin , 15 mg/kg body weight per day in a single morning dose , for 45 days ; 51 patients received the same dose of doxycycline for 45 days plus streptomycin , 1 g/d for 15 days . MAIN OUTCOME MEASURES Therapeutic failure and relapse during the follow-up period . RESULTS The mean time to defervescence was 4.2 days for the DR group and 3.2 days for the DS group ( P greater than 0.2 ) . The actuarial probability of therapeutic failure or relapse at 12 months of follow-up ( Kaplan-Meier ) was 14.4 % in the DR group and 5.9 % in the DS group ( difference , 8.5 % ; 95 % Cl , -4.8 % to 21.6 % ; P greater than 0.2 ) . All three patients with spondylitis in the DR group failed therapy compared with one of four patients in the DS group . Excluding patients with spondylitis , the actuarial failure rate was 4.9 % and 4.3 % in the DR and DS groups , respectively , at 12 months of follow-up ( difference , 0.6 % ; Cl , -8.1 % to 9.4 % ; P greater than 0.2 ) . CONCLUSIONS Doxycycline-rifampin combination therapy for 45 days is as effective as the classic DS combination in most patients with brucellosis ; however , DR therapy might be less effective in those patients with spondylitis Abstract Brucellosis , a zoonosis with worldwide distribution , is a systemic infection and still an important public health problem in Turkey . The best antimicrobial combination and schedule for the treatment of brucellosis with spondylitis has not yet been clearly determined . In a prospect i ve and r and omized study , we compared the efficacy of five antimicrobial regimens for treatment of 102 patients with lumbar brucellar spondylitis . Patients were r and omly assigned to receive antimicrobial combination therapy . Twenty patients received streptomycin 1 g/day intramuscularly for 15 days and tetracycline-HCl , 500 mg every 6 h orally for 45 days ( ST ) , 21 patients received streptomycin 1 g/day i.m . for 15 days and doxycycline 100 mg every 12 h orally for 45 days ( SD ) , 20 patients received doxycycline 100 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days ( DR ) , 19 patients received ofloxacin , 200 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days ( OR ) , and 22 patients received streptomycin 1 g/day i.m . for 15 days and doxycycline 100 mg every 12 h orally for 45 days plus rifampicin 15 mg/kg per day in a single morning dose orally for 45 days ( SDR ) . Initial therapeutic failure occurred in 2 patients ( 10 % ) in the ST regimen group ,  
    Output:
    
Doxycycline ( six weeks ) plus streptomycin ( two or three weeks ) regimen is more effective regimen than doxycycline plus rifampicin ( six weeks ) regimen .
Since it needs daily intramuscular ( IM ) injection , access to care and cost are important factors in deciding between two choices .
Quinolone plus rifampicin ( six weeks ) regimen is slightly better tolerated than doxycycline plus rifampicin , and low quality evidence did not show any difference in overall effectiveness