Nocardiosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Nocardiosis requires at least 6 months of treatment, preferably with co-trimoxazole or high doses of sulfonamides. In patients who don’t respond to sulfonamide treatment, other drugs, such as ampicillin, erythromycin, or minocycline, may be added. Treatment also includes surgical drainage of abscesses and excision of necrotic tissue. The acute phase requires complete bed rest; as the patient improves, activity can increase. A new combination drug therapy (sulfonamide, ceftriaxone, and amikacin) has also shown promise.

Antimicrobial regimen

  • 1. Sulfonamide-based therapies [1]
  • 1.1 Pulmonary
  • Preferred regimen: TMP-SMX 10 mg/kg/day (TMP) in 2-4 divided doses IV for 3-6 weeks THEN 2 DS PO bid for at least 5 months
  • 1.2 Pulmonary alternatives
  • 1.3 CNS (AIDS, severe or disseminated disease)
  • Preferred regimen: TMP-SMX 15 mg/kg/day (TMP) IV for 3-6 weeks THEN 3 DS PO bid for 6-12 months
  • 1.4 CNS alternatives
  • 1.5 Severe disease, compromised host, multiple sites
  • 1.6 Sporotrichoid (cutaneous)
  • Preferred regimen: TMP-SMX 1 DS bid for 4-6 months
  • Note (1): Immunocompetent medicine use for 6 months; Immunosuppressed medicine for 12 months
  • Note (2): Treat based on host, site of disease and in vitro activity; Sulfonamide usually preferred, must treat for 6-12 months; Preferred drugs for resistant strains are Amikacin and/or Imipenem
  • Note (3): Seriously ill usually treated with IV Imipenem or Sulfonamide or Cefotaxime all potentially combined with Amikacin; less seriously ill treated with oral agents— especially TMP-SMX or Minocycline
  • 2. Sulfonamide alternatives
  • 2.1 Severe
  • 2.2 Mild

References

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

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