Mycobacterium abscessus medical therapy: Difference between revisions
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===Pulmonary Infection=== | ===Pulmonary Infection=== | ||
The treatment of pulmonary ''M. abscessus'' infection includes: | |||
* A combination of antibiotics | |||
* Surgical resection of the localized disease<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref> | * Surgical resection of the localized disease<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref> | ||
** Surgical resection and multidrug antibiotic therapy is associated with a higher chance of a successful treatment. | ** Surgical resection and multidrug antibiotic therapy is associated with a higher chance of a successful treatment. | ||
====Antibiotic Regimen==== | |||
There is no optimal multidrug regimen for the treatment of pulmonary ''M. abscessus'' infection. A successful treatment is defined by having 12 months of negative sputum culture. In the majority of the cases, pulmonary ''M. abscessus'' infection is chronic and incurable. | |||
The suggested combination of [[antibiotic]]s to be administered is:<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref> | |||
* [[Macrolide]]: [[clarithromycin]] ''OR'' [[azithromycin]] | |||
''PLUS'' | |||
* [[Amikacin]] | |||
''PLUS'' | |||
* [[Cefoxitin]] ''OR'' [[imipenem]] | |||
Note that, in case of [[macrolide]] resistance, the antibiotic therapy should be chosen based on the suscepibility profile of ''M. abscessus''. | |||
====duration of the Antibiotic Regimen==== | |||
2-4 months | |||
==References== | ==References== | ||
Revision as of 20:43, 23 July 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
The treatment of mycobacterium abscessus (M. abscessus) skin and soft tissue infection includes draining collections of pus, surgical debridement, and administration of combination of antibiotics. M. abscessus has a variable in vitro drug susceptibilities profile; therefore, antibiotic susceptibility testing is required. M. abscessus infection is treated by a macrolide-based multidrug antibiotic regimen.
Medical Therapy
Skin and Soft Tissue Infections
The treatment of M. abscessus includes the following:
- Draining collections of pus
- Surgical debridement[1]
- Administration of combination of antibiotics for a prolonged period of time: macrolide based regimen[1]
Antibiotic Regimen
In case of serious skin, soft tissues, and bones infection, a combination of antibiotics need to be administered:[1]
PLUS
Note that, during the initial therapy, amikacin should be administered with cefoxitin up to two weeks or until the patient improves clinically.[1]
Antibiotic Dosage
| Antibiotic | Dosage |
| Clarithromycin | 1,000 mg/day[1] |
| Azithromycin | 250 mg/day[1] |
| Amikacin |
Once a day regimen
|
| Cefoxitin | High dose, up to 12 g/day, divided dose[1] |
| Imipenem | 500 mg, 2-4 times/day[1] |
Antibiotic Duration of Therapy
- Skin or soft tissue infection: At least 4 months[1]
- Bone infection: 6 months[1]
Pulmonary Infection
The treatment of pulmonary M. abscessus infection includes:
- A combination of antibiotics
- Surgical resection of the localized disease[1]
- Surgical resection and multidrug antibiotic therapy is associated with a higher chance of a successful treatment.
Antibiotic Regimen
There is no optimal multidrug regimen for the treatment of pulmonary M. abscessus infection. A successful treatment is defined by having 12 months of negative sputum culture. In the majority of the cases, pulmonary M. abscessus infection is chronic and incurable.
The suggested combination of antibiotics to be administered is:[1]
PLUS
PLUS
Note that, in case of macrolide resistance, the antibiotic therapy should be chosen based on the suscepibility profile of M. abscessus.
duration of the Antibiotic Regimen
2-4 months
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F; et al. (2007). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". Am J Respir Crit Care Med. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. PMID 17277290.