Treatment of brucellosis in pregnant women: a systematic review and analysis of current gaps and future perspectives

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: 16% adverse obstetric outcomes

• Primary Outcome: Adverse obstetric outcomes with sulfamethoxazole-trimethoprim plus rifampicin

• Nnt Or Sensitivity: Overall abortion rate 23.3% (94/403 women), recurrence rate 3%

• Confidence Interval: 95% CI: 8%-30%

Clinical Application

Limited by lack of standardized protocols and need for individualized risk-benefit assessment Limited relevance as brucellosis is rare in Australia; may apply to imported cases or travel-related infections. TGA-approved antibiotics available but pregnancy safety considerations paramount Pregnant women with confirmed brucellosis, particularly in endemic areas

Abstract

Human brucellosis is a globally prevalent bacterial disease with significant implications during pregnancy due to obstetric complications. Despite the importance of early diagnosis and treatment, the lack of therapeutic consensus and robust evidence underscores the need for systematic evaluation to guide clinical practice. This study systematically reviewed the literature to identify and summarize available drug therapy options for brucellosis in pregnant women, focusing on efficacy, safety, and obstetric outcomes. The review followed PRISMA and Cochrane Handbook guidelines. Searches were conducted in MEDLINE, Embase, Cochrane Library, LILACS, and gray literature for references indexed up to September 15, 2025. Eligible studies reported therapeutic interventions in pregnant women with brucellosis. Risk of bias was assessed using the JBI Critical Appraisal tool, and data on participants, interventions, and outcomes were extracted. Of 737 records screened, six studies met the inclusion criteria, comprising retrospective and prospective reports published between 1991 and 2020, totaling 403 pregnant women. Therapeutic regimens varied, with sulfamethoxazole-trimethoprim (SMX-TMP) plus rifampicin being the most frequently used combination. Adverse obstetric outcomes associated with this regimen occurred in 16% (95%CI: 8%-30%) of cases. Overall, abortion occurred in 94 (23.3%) women, 20 preterm births were reported, and 10 newborns had low birth weight. Recurrence was observed in only 3% of cases. Heterogeneity in outcomes and definitions limited comparability. In conclusion, there is no standardized treatment for brucellosis during pregnancy. Adverse obstetric outcomes remain frequent, highlighting the need for controlled studies to establish safe and effective therapeutic protocols.

References

1. 1.Galvão, E. L., Xavier, D. M., Souza, G. M., Cota, G., & Silva, S. N. (2026). Treatment of brucellosis in pregnant women: a systematic review and analysis of current gaps and future perspectives. Revista do Instituto de Medicina Tropical de Sao Paulo, 68, 032. https://doi.org/10.1590/S1678-9946202668032