Use of Gentamicin for Childhood Brucellosis: Effect on Calcium Homeostasis and Relapse

Abstract

Objective: Brucellosis is a permanent health problem in many developing countries globally, and the search for simple and effective treatments is of high importance. Gentamicin, used in the treatment of brucellosis, has effects on calcium homeostasis as an extracellular calcium-sens-ing receptor (CaSR) agonist. In this study, it was aimed to compare post-treatment relapse rates between patients who were administered with intravenous gentamicin for 14 days and patients who were administered oral antibiotics in order to investigate the effects of gentamicin on calcium homeostasis. Material and Methods: Retrospectively, a positive Rose Bengal test result in patients younger than 18 years, Wright agglutination titer ≥1/160 or Brucella spp. patients diagnosed with brucellosis in any of the culture samples were scanned through their files. Patients receiving oral therapy (Group 1/Regimen 1) and patients receiving intravenous therapy (Group 2/Regimen 2), complete blood count (hemogram); erythrocyte sedimentation rate; spot urinary electrolyte levels; and serum urea, cre-atinine, aspartate aminotransferase, alanine aminotransferase, calcium, phosphorus, magnesium, alkaline phosphatase, PTH, 25 hydroxy vitamin D3, albumin, total protein and electrolyte levels were evaluated. Results: There was a statistically significance variability in serum potas-sium, calcium, and phosphorus levels, parathyroid hormone, 25-dihy-droxyvitamin D3, and alkaline phosphatase in the patients who were administered with gentamicin. In seven of the 21 patients (33.3%) who were administered with Regimen 1, relapse/treatment failure was observed within the first six months after the treatment. There was no relapse observed in any of the 61 patients who were administered with Regimen 2. Conclusion: Fourteen days of intravenous gentamicin with 45 days of doxycycline/trimethoprim-sulphamethoxazole treatment can be administered in order to eliminate relapse risk in the treatment of childhood brucellosis. Gentamicin, used as a CaSR agonist, may cause temporary changes in calcium homeostasis.