Mycobacterium abscessus medical therapy: Difference between revisions

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Revision as of 19:54, 23 July 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Medical Therapy

Skin and Soft Tissue Infections

The treatment of mycobacterium abscessus include 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:

Macrolide: clarithromycin OR azithromycin

PLUS

Parenteral antibiotics: amikacin OR cefoxitin OR imipenem

Antibiotic Dosage

Antibiotic	Dosage
Clarithromycin	1,000 mg/day
Azithromycin	250 mg/day
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
Cefoxitin	High dose, up to 12 g/day, divided dose
Imipenem	500 mg, 2-4 times/day

Pulmonary Infection

Administration of combination of antibiotics for a prolonged period of time: clarithromycin 1,000 mg/day based regimen^[1]
- A combination of antibiotics is indicated for the treatment of pulmonary infection with mycobacterium abscessus; however, there is no evidence on the optimal multidrug regimen.
Surgical resection of the localized disease^[1]
- Surgical resection and multidrug antibiotic therapy is associated with a higher chance of a successful treatment.

References

↑ ^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.

Template:WikiDoc Sources

[pmid17277290-1] 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.

[1]

@@ Line 23: / Line 23: @@
 | 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 |
+|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
 |-
-|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Azithromycin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |
+|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
 |-
 |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
 |-
-|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Cefoxitin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |
+|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
 |-
-|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Imipenem]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |
+|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
 |-
 |}