Efficacy and safety of fluoroquinolones in the treatment of human brucellosis: A systematic review and meta-analysis
6 affiliations
- 1Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- 2Department of Nutrition, Islamic Azad University, Rasht Branch, Rasht, Iran
- 3Zoonoses Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- 4Nutrition Research Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- 5Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden
- 6Faculty of Medicine, Bogomolets National Medical University, Kyiv, Ukraine
Abstract
Introduction: Brucellosis is a major zoonotic infection worldwide, with the highest burden reported in the Mediterranean region. The therapeutic role of fluoroquinolones in this disease continues to be controversial. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of fluoroquinolone-containing regimens compared with standard non-fluoroquinolone regimens for the treatment of human brucellosis. Methods: In accordance with PRISMA recommendations, this systematic review and meta-analysis assessed the efficacy and safety of fluoroquinolone-based regimens for treating brucellosis. It was prospectively registered in PROSPERO (CRD420251142019). A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was carried out, including studies published through August 2025. Randomized controlled trials comparing fluoroquinolones with conventional therapies (such as doxycycline with streptomycin or rifampicin) were included. Therapeutic failure, relapse, adverse events, and time to defervescence were the main outcomes. To compute pooled risk ratios and mean differences with 95%CIs, data were analyzed using STATA v18. The GRADE method and the RoB 2 tool were used to evaluate the risk of bias and the certainty of the evidence. Results: The analysis comprised 9 clinical studies with 602 brucellosis patients. When compared to standard regimens, fluoroquinolone-based regimens were linked to a significantly higher risk of therapeutic failure (RR = 2.11, 95% CI: 1.26–3.51; P = 0.004) and a higher, though not statistically significant, risk of relapse (RR = 1.88, 95% CI: 0.94–3.74; P = 0.07). No statistically significant between-study heterogeneity was observed for either outcome (I² = 0%). Subgroup analyses showed a significantly increased risk of therapeutic failure in patients with uncomplicated brucellosis and in studies with treatment durations >8 weeks, although between-subgroup differences were not statistically significant. On the other hand, no statistically significant difference in adverse events was observed between fluoroquinolone-based and standard regimens under the random-effects model (RR = 0.62, 95% CI: 0.29–1.33; P = 0.22). Although the point estimate favored fluoroquinolone-based regimens, the confidence interval included the null effect. Fluoroquinolone-based regimens were also associated with a significantly longer time to defervescence compared with standard regimens (MD = 1.20 days, 95% CI: 0.66–1.74; P < 0.001). The certainty of evidence was moderate for therapeutic failure, and time to defervescence, and low for relapse and adverse events according to the GRADE evaluation. Conclusion: Compared with conventional doxycycline-based combinations, fluoroquinolone-based regimens were associated with a higher risk of therapeutic failure and longer time to defervescence, while the overall risk of relapse did not differ significantly. No significant difference in adverse events was observed with the random-effects model, although the point estimate favored fluoroquinolone-based regimens. Overall, these findings do not support the routine use of fluoroquinolones as first-line therapy for adult brucellosis. Further well-designed randomized controlled trials are needed. Author summary: Brucellosis is a zoonotic infection in which treatment failure and relapse remain important concerns. We compared fluoroquinolone-based regimens with standard treatments for human brucellosis. Fluoroquinolone-based regimens were associated with more treatment failures and a longer time to defervescence, while the overall risk of relapse was not significantly different. No significant difference in adverse events was found with the random-effects analysis, although the results tended to favor fluoroquinolones. Overall, these findings do not support the routine use of fluoroquinolones as first-line therapy. Established doxycycline-based combination regimens remain preferred treatment options.
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BibTeX
@article{mohammadisartang2026efficacy,
title = {{Efficacy and safety of fluoroquinolones in the treatment of human brucellosis: A systematic review and meta-analysis}},
author = {Mohsen Mohammadi-Sartang and Nastaran Rafieipour and Shahla Afrasiabian and Roya Mahmoudi and Yousef Moradi and Mehdi Karimi and Karo Servatyari},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0013822},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0013822},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Efficacy and safety of fluoroquinolones in the treatment of human brucellosis: A systematic review and meta-analysis
AU - Mohsen Mohammadi-Sartang
AU - Nastaran Rafieipour
AU - Shahla Afrasiabian
AU - Roya Mahmoudi
AU - Yousef Moradi
AU - Mehdi Karimi
AU - Karo Servatyari
PY - 2026
DA - 2026/10/23
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0013822
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0013822
AB - Introduction: Brucellosis is a major zoonotic infection worldwide, with the highest burden reported in the Mediterranean region. The therapeutic role of fluoroquinolones in this disease continues to be controversial. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of fluoroquinolone-containing regimens compared with standard non-fluoroquinolone regimens for the treatment of human brucellosis. Methods: In accordance with PRISMA recommendations, this systematic review and meta-analysis assessed the efficacy and safety of fluoroquinolone-based regimens for treating brucellosis. It was prospectively registered in PROSPERO (CRD420251142019). A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was carried out, including studies published through August 2025. Randomized controlled trials comparing fluoroquinolones with conventional therapies (such as doxycycline with streptomycin or rifampicin) were included. Therapeutic failure, relapse, adverse events, and time to defervescence were the main outcomes. To compute pooled risk ratios and mean differences with 95%CIs, data were analyzed using STATA v18. The GRADE method and the RoB 2 tool were used to evaluate the risk of bias and the certainty of the evidence. Results: The analysis comprised 9 clinical studies with 602 brucellosis patients. When compared to standard regimens, fluoroquinolone-based regimens were linked to a significantly higher risk of therapeutic failure (RR = 2.11, 95% CI: 1.26–3.51; P = 0.004) and a higher, though not statistically significant, risk of relapse (RR = 1.88, 95% CI: 0.94–3.74; P = 0.07). No statistically significant between-study heterogeneity was observed for either outcome (I² = 0%). Subgroup analyses showed a significantly increased risk of therapeutic failure in patients with uncomplicated brucellosis and in studies with treatment durations >8 weeks, although between-subgroup differences were not statistically significant. On the other hand, no statistically significant difference in adverse events was observed between fluoroquinolone-based and standard regimens under the random-effects model (RR = 0.62, 95% CI: 0.29–1.33; P = 0.22). Although the point estimate favored fluoroquinolone-based regimens, the confidence interval included the null effect. Fluoroquinolone-based regimens were also associated with a significantly longer time to defervescence compared with standard regimens (MD = 1.20 days, 95% CI: 0.66–1.74; P < 0.001). The certainty of evidence was moderate for therapeutic failure, and time to defervescence, and low for relapse and adverse events according to the GRADE evaluation. Conclusion: Compared with conventional doxycycline-based combinations, fluoroquinolone-based regimens were associated with a higher risk of therapeutic failure and longer time to defervescence, while the overall risk of relapse did not differ significantly. No significant difference in adverse events was observed with the random-effects model, although the point estimate favored fluoroquinolone-based regimens. Overall, these findings do not support the routine use of fluoroquinolones as first-line therapy for adult brucellosis. Further well-designed randomized controlled trials are needed. Author summary: Brucellosis is a zoonotic infection in which treatment failure and relapse remain important concerns. We compared fluoroquinolone-based regimens with standard treatments for human brucellosis. Fluoroquinolone-based regimens were associated with more treatment failures and a longer time to defervescence, while the overall risk of relapse was not significantly different. No significant difference in adverse events was found with the random-effects analysis, although the results tended to favor fluoroquinolones. Overall, these findings do not support the routine use of fluoroquinolones as first-line therapy. Established doxycycline-based combination regimens remain preferred treatment options.
SN - 1935-2735
SN - 1935-2727
ER -