Inability to tolerate oral medications due to nausea or vomiting
Signs of drug reaction — widespread rash, fever, swollen face
Medication side effects to monitor
TMP-SMX (trimethoprim-sulfamethoxazole)
Rash — stop and seek care immediately if widespread
GI upset — take with food to reduce nausea
Blood tests required during treatment to monitor kidneys and blood count
Amoxicillin-clavulanate (if prescribed instead)
Diarrhoea — report if severe or bloody
Take with food to reduce stomach upset
Follow-up appointments
Infectious Disease clinic within 1 week of discharge
Monthly visits during eradication treatment phase
Blood tests and imaging to be arranged by your doctor
Repeat imaging to confirm abscess resolution
Do not skip imaging follow-up even if feeling well
Lifestyle and prevention
If returning to work involving soil or water exposure, discuss timing with your Infectious Disease doctor
Wear protective footwear and gloves in endemic soil environments
Diabetes optimisation prevents recurrence
References
Guidelines and key sources
Primary clinical references
Meumann EM et al. Burkholderia pseudomallei and Melioidosis. Nature Reviews Microbiology. 2024. PMID 37794173
Comprehensive 2024 review — primary source for epidemiology, treatment, and pathogenesis
Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. New England Journal of Medicine. 2012. NEJM doi:10.1056/NEJMra1204699
Landmark clinical review covering all major aspects
Currie BJ et al. The Darwin Prospective Melioidosis Study: A 30-year prospective observational investigation. Lancet Infectious Diseases. 2021. PMID 34303419
Largest single-centre prospective dataset; mortality, epidemiology, treatment outcomes
Treatment evidence
Chetchotisakd P et al. MERTH Trial — TMP-SMX versus TMP-SMX plus doxycycline for eradication. Lancet. 2014. PMID 24284287
Establishes TMP-SMX monotherapy as standard eradication regimen
Meumann EM et al. Treatment of Melioidosis. Infectious Disease Clinics of North America. 2026. PMID 41571490
Most recent treatment guideline update
Epidemiology and burden
Birnie E et al. Global burden of melioidosis in 2015. Lancet Infectious Diseases. 2019. PMID 31285144
Estimated 165,000 cases and 89,000 deaths per year worldwide
Petras JK et al. Locally acquired melioidosis linked to environment — Mississippi 2020–2023. NEJM. 2023.
Documents emergence of melioidosis in southern United States
Imaging and diagnostics
Muttarak M et al. Spectrum of imaging findings in melioidosis. British Journal of Radiology. 2009. PMID 19098086
Comprehensive imaging characterization across clinical syndromes
ICD-10-CM A24.1 — Acute and fulminating melioidosis
ICD-10-CM A24.2 — Subacute and chronic melioidosis
ICD-10-CM A24.3 — Other melioidosis
ICD-10-CM A24.9 — Melioidosis, unspecified
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.