Adjunctive Therapy
Surgical drainage of large abscesses is indicated, but this is usually not
necessary or possible for multiple small abscesses in the spleen and
liver. Parotid abscesses require careful incision and drainage. Prostatic
abscesses can often be drained under ultrasound guidance using a rectal probe, with transurethral resection reserved for failures of the simpler procedure.
State-of-the-art intensive care management has resulted in decreased
mortality in patients with melioidosis septic shock. The possible
primary role of neutrophil function in containing B. pseudomallei has
led to the empirical use of granulocyte colony-stimulating factor
(G-CSF) in patients with strictly defined septic shock, with observational
data from Australia showing a significant improvement in survival
with G-CSF.100 Nevertheless, a randomized controlled trial in
Thailand has shown no survival benefit of G-CSF in that location.101