Brucellosis is a systemic disease and may affect many organ systems. However, musculoskeletal involvement represents 10-85% of the focal complications. Involvement of the spine is one of the most common localized forms of human brucellosis, especially in elderly patients. It is a destructive disease that requires a correct and early diagnosis, and immediate treatment. However, controversy remains over the optimal duration and antimicrobial regimen required for the treatment of spinal brucellosis. Relapses and sequetae are stilt reported. In recent years, in order to improve outcomes, alternative regimens have been investigated. However, the classical regimen (doxycycline, 100 mg twice daily, for at least 12 weeks combined with streptomycin, 1 g daily, for the first 2 or 3 weeks) remains the first choice of antibiotic therapy. Alternative therapies (rifampin, fluoroquinolones, co-trimoxazole) should be considered when adverse reactions or contraindications to the above drugs (ototoxicity, nephrotoxicity, pregnancy, etc.) are reported. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.