The dosing regimen for co-trimoxazole (trimethoprim/sulfamethoxazole) in eradication phase is 6/30 mg/kg, up to maximum 240/1200 mg in children, 240/1200 mg in adults weighing 40 to 60 kg, and 320/1600 mg in adults weighing more than 60 kg, taken orally every 12 hours. In both Thailand and Australia, co-trimoxazole is taken together with folic acid (0.1 mg/kg up to 5 mg in children). There are also cases where melioidosis is successfully treated with co-trimoxazole for 3 months without going through intensive therapy provided that there is only skin manifestations without the involvement of internal organs or sepsis. Resistance to cotrimoxazole is rare in Asia. Besides that, it is difficult to determine the resistance reliably because resistance to cotrimoxazole is defined when minimum inhibitory concentration (MIC) of more than 4 mg/L is required to completely inhibit the growth of 80% of the bacteria (80% inhibition point). Interpretation of 80% inhibition point is subjective and prone to human error. In 2021, European Committee on Antimicrobial Susceptibility Testing (EUCAST) released a new guideline on interpreting the susceptibility of B pseudomallei towards various antibiotics on disc susceptibility testing. The new guideline includes "S" for susceptible organism, "I" for susceptible organism only after increased exposure (when dosage or concentration of the drug increases) and "R" for resistant organism. Surgery
Surgical drainage is indicated for single, large abscesses in the liver, muscle, and prostate. However, for multiple abscesses in the liver, spleen, and kidney, surgical drainage may not be possible or necessary. For septic arthritis, arthrotomy washout and drainage are required.
Bevacizumab is an anti-VEGF drug used in intravitreal injection that is known to cause reversal of sea fan lesions and reduce the duration of vitreous hemorrhage. Intravitreal injection of anti-VEGF drugs can also be used prior to surgery to aid separation of tissues involved in the sea fan lesion and to reduce intraoperative and postoperative hemorrhage. It is useful in combination with photocoagulation. Laser
Indications for laser photocoagulation include
Peripheral neovascularization of upwards of 60° circumference
Sickle cell retinopathy affecting both eyes
Large elevated sea fans
Rapid progression of neovascularizationThere are two methods of photocoagulation mainly used; feeder vessel coagulation and scatter laser coagulation. The first method closes the vessels that supply the neovascularized areas using laser burns. Both the xenon arc and argon laser can be used however, the argon laser carries a reduced risk of complications. In comparison, scatter laser coagulation has an indirect effect. Ischemic retina produces vascular endothelial growth factor (VEGF) which  promotes neovascularization. Scatter laser coagulation destroys this ischemic retina using laser burns thus preventing vitreous hemorrhage, retinal detachment and vision loss. Surgery
Surgical intervention is indicated for severely advanced disease that poses a threat to visual acuity. Indications include longstanding vitreous haemorrhage, vitreous haemorrhage in both eyes, vitreous haemorrhage in patients with only one eye, epiretinal membranes, macular holes and the various forms of retinal detachment. Scleral buckle was a previously popular surgical intervention however, its complications include anterior segment ischemia as a result of vascular occlusion. The vascular occlusion can in turn lead to phthisis bulbi.