ABSTRACT
Melioidosis has diverse clinical presentations: pneumonia to septicemia, bacteremia without evident focus, severe sepsis with multiple organ abscesses, septic arthritis and osteomyelitis, and all the diseases may start from localized cutaneous lesion. Therapy consists of an intensive intravenous phase and an oral eradication phase. B pseudomallei has broad intrinsic antimicrobial resistance and prolonged therapy is required for a cure, comprising an intensive intravenous phase with ceftazidime, meropenem, or imipenem, followed by an oral eradication phase of at least 12 weeks, usually with trimethoprim-sulfamethoxazole. The duration of deep-seated collection, central nervous system infection, and arterial infection require a 6–8 weeks intensive phase and a minimum of a 6-month eradication phase. The 2020 revision now includes multi-lobar pneumonia as an indication for a minimum of 3 weeks of intravenous treatment if bacteremia is not present and 4 weeks if bacteremia is present, while a minimum of 3 weeks is recommended for those with concurrent bacteremia and pneumonia involving only a single lobe.
