Mycobacterium abscessus medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
m (Changes made per Mahshid's request)
 
(6 intermediate revisions by 4 users not shown)
Line 4: Line 4:


==Overview==
==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 [[antibiotic]]s.  ''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 [[antibiotic]]s 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
The treatment of ''Mycobacterium abscessus'' (''M. abscessus'') [[skin and soft tissue infection]] includes draining collections of [[pus]], [[surgical debridement]], and administration of combination of [[antibiotic]]s.  ''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 [[antibiotic]]s 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==
==Medical Therapy==
Line 12: Line 12:
* [[Surgical debridement]]<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 debridement]]<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>
* Administration of combination of [[antibiotic]]s for a prolonged period of time ([[macrolide]] based regimen)<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>
* Administration of combination of [[antibiotic]]s for a prolonged period of time ([[macrolide]] based regimen)<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>
====Antibiotic Regimen====
In case of serious skin, soft tissues, and bones infection, a combination of [[antibiotic]]s need to be administered:<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''
* Parenteral antibiotics: [[amikacin]], [[cefoxitin]] ''OR'' [[imipenem]]
Note that, during the initial therapy, [[amikacin]] should be administered with [[cefoxitin]] up to two weeks or until the patient improves clinically.<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>
====Antibiotic Dosage====
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |Antibiotic ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |Dosage
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Clarithromycin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |1,000 mg/day<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>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Azithromycin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | 250 mg/day<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>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Amikacin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |
''Once a day regimen'' <br>
- Adults <50 years and normal renal function: 10-15 mg/kg <br>
- Age >50 years and/or anticipated long term therapy for more than 3 weeks: 10 mg/kg <br>
''Three times per week regimen'' <br>
- 25 mg/kg<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>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Cefoxitin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | High dose, up to 12 g/day, divided dose<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>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Imipenem]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | 500 mg, 2-4 times/day<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>
|-
|}
====Antibiotic Duration of Therapy====
* [[Skin or soft tissue infection]]: At least 4 months<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>
* [[Bone]] infection: 6 months<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>


===Pulmonary Infection===
===Pulmonary Infection===
Line 54: Line 18:
* 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>


====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 [[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>
==Treatment==
* [[Macrolide]]: [[clarithromycin]] ''OR'' [[azithromycin]]
 
''PLUS''
*1.'''Limited, localized extrapulmonary disease ''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
* [[Amikacin]]
 
''PLUS''
:* Preferred regimen: [[Clarithromycin]] 500 mg PO bid {{withorwithout}} [[Amikacin]] 10-15 mg/kg/day IV or 25 mg/kg three times weekly for 4 months
* [[Cefoxitin]] ''OR'' [[imipenem]]


Note that, in case of [[macrolide]] resistance, the antibiotic therapy should be chosen based on the suscepibility profile of ''M. abscessus''.
:* Alternative regimen (1): [[Amikacin]] {{and}} [[Cefoxitin]] 12 g/day PO for two weeks
:* Note: until clinical improvement in severe cases


====Duration of the Antibiotic Regimen====
:* Alternative regimen (2): [[Amikacin]] {{and}} [[Imipenem]] 500 mg IV q6-8h for two weeks
2-4 months
:* Note(1): Until clinical improvement in severe cases
:* Note(2): Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed


*2.'''Pulmonary or serious extrapulmonary disease'''
:* Preferred regimen: [[Clarithromycin]] 500 mg PO bid {{and}} [[Amikacin]] 15 mg/kg/day IV {{and}} [[Cefoxitin]] 2g IV q4h {{or}} [[Imipenem]] 1g IV q6h for at least 2-4 months
:* Note: If limited by adverse effects {{then}} [[Clarithromycin]] 500 mg PO bid or 1000 mg XR qd {{or}} [[Azithromycin]] 250 mg PO qd
:* Alternative regimen(1): [[Tigecycline]] 100 mg IV loading dose {{then}} 50 mg IV q12h
:* Note: could be substituted as one of the injectables
:* Alternative regimen(2): [[Linezolid]] 600 mg PO bid or 600 mg PO qd {{and}} [[Clarithromycin]]
:* Note: Could replace parental tx if not tolerated or feasible
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
Line 74: Line 44:
[[Category:Acid fast bacilli]]
[[Category:Acid fast bacilli]]
[[Category:Nontuberculous mycobacteria]]
[[Category:Nontuberculous mycobacteria]]
[[Category:Infectious disease]]


{{WikiDoc Help Menu}}
[[Category:Infectious Disease Project]]
{{WikiDoc Sources}}

Latest revision as of 18:08, 18 September 2017

Mycobacterium Abscessus Microchapters

Home

Patient Information

Overview

Historical Perspective

Causes

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Other Imaging Findings

Treatment

Medical Therapy

Surgery

Primary Prevention

Case Studies

Case #1

Mycobacterium abscessus medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Mycobacterium abscessus medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Mycobacterium abscessus medical therapy

CDC on Mycobacterium abscessus medical therapy

Mycobacterium abscessus medical therapy in the news

Blogs on Mycobacterium abscessus medical therapy

Directions to Hospitals Treating Mycobacterium abscessus

Risk calculators and risk factors for Mycobacterium abscessus medical therapy

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:

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]


Treatment

  • 1.Limited, localized extrapulmonary disease [2]
  • Preferred regimen: Clarithromycin 500 mg PO bid ± Amikacin 10-15 mg/kg/day IV or 25 mg/kg three times weekly for 4 months
  • Alternative regimen (1): Amikacin AND Cefoxitin 12 g/day PO for two weeks
  • Note: until clinical improvement in severe cases
  • Alternative regimen (2): Amikacin AND Imipenem 500 mg IV q6-8h for two weeks
  • Note(1): Until clinical improvement in severe cases
  • Note(2): Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed
  • 2.Pulmonary or serious extrapulmonary disease
  • Preferred regimen: Clarithromycin 500 mg PO bid AND Amikacin 15 mg/kg/day IV AND Cefoxitin 2g IV q4h OR Imipenem 1g IV q6h for at least 2-4 months
  • Note: If limited by adverse effects THEN Clarithromycin 500 mg PO bid or 1000 mg XR qd OR Azithromycin 250 mg PO qd
  • Alternative regimen(1): Tigecycline 100 mg IV loading dose THEN 50 mg IV q12h
  • Note: could be substituted as one of the injectables
  • Alternative regimen(2): Linezolid 600 mg PO bid or 600 mg PO qd AND Clarithromycin
  • Note: Could replace parental tx if not tolerated or feasible

References

  1. 1.0 1.1 1.2 1.3 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.
  2. Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.