Mycobacterium abscessus medical therapy

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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. The treatment of pulmonary M. abscessus infection includes a combination of antibiotics and surgical resection of the localized disease. M. abscessus infection is treated by a macrolide-based multidrug antibiotic regimen. The duration of the antibiotic regimen depends on the site of infection: 2-4 months in pulmonary infection, at least 4 months in skin and soft tissue infection, and 6 months for bone infection.

Medical Therapy

Skin and Soft Tissue Infections

The treatment of M. abscessus includes the following:

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
- Adults <50 years and normal renal function: 10-15 mg/kg
- Age >50 years and/or anticipated long term therapy for more than 3 weeks: 10 mg/kg


Three times per week regimen
- 25 mg/kg[1]

Cefoxitin High dose, up to 12 g/day, divided dose[1]
Imipenem 500 mg, 2-4 times/day[1]

Antibiotic Duration of Therapy

Pulmonary Infection

The treatment of pulmonary M. abscessus infection includes:

  • Administration of combination of antibiotics for a prolonged period of time (macrolide based regimen)[1]
  • Surgical resection of the localized disease[1]

Antibiotic Regimen

There is no optimal multidrug regimen for the treatment of pulmonary M. abscessus infection. A successful treatment is defined by 12 months of negative sputum culture. In the majority of 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. 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 1.13 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.


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