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A four-drug combination regimen used primarily for the oral maintenance treatment phase of melioidosis following initial intravenous therapy. This combination targets bacterial protein synthesis and folate metabolism through multiple mechanisms. While effective in preventing relapse of melioidosis, this regimen is associated with significant adverse effects, particularly gastrointestinal intolerance and anemia, leading to frequent treatment modifications. Clinical trials have shown that a three-drug regimen (without chloramphenicol) may be equally effective with better tolerability.
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