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==Medical Therapy==
==Medical Therapy==
Nocardiosis requires at least 6 months of treatment, preferably with [[co-trimoxazole]] or high doses of [[sulfonamide]]s. 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 [[abscess]]es 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.
Nocardiosis requires at least 6 months of treatment, preferably with [[co-trimoxazole]] or high doses of [[sulfonamide]]s. 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 [[abscess]]es 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''' <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>
:*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'''
::* Preferred regimen: [[Sulfisoxazole]] {{or}} [[Sulfadiazine]] {{or}} Trisulfapyrimidine 3-6 g/day in 2-4 divided doses PO {{or}} [[TMP-SMX]] 2 DS bid up to 2 DS tid
:*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'''
::* Preferred regimen: [[Imipenem]] 1000 mg IV q8h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2-3 g IV q6h {{and}} [[Amikacin]]
:*1.5 '''Severe disease, compromised host, multiple sites'''
::* Preferred regimen: [[TMP-SMX]] 15 mg/kg/day (TMP) IV {{and}} [[Amikacin]] 7.5 mg/kg q12h {{or}} [[Sulfonamide]] 6-12 mg/day PO
:*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'''
::* Preferred regimen (1): (For AIDS) ([[Imipenem]] 1000 mg IV q8h {{or}} [[Meropenem]] 2 g q8h {{and}} [[Amikacin]] 7.5 mg/kg q12h IV
::* Preferred regimen (2): [[Cefotaxime]] 2-3 g q6-8h {{or}} [[Ceftriaxone]] 2 g/day IV {{withorwithout}} [[Amikacin]]
:*2.2 '''Mild'''
::* Preferred regimen: [[Minocycline]] 100 mg bid for at least 6 months (initial treatment of local disease or maintenance)
::* Alternative regimen: [[Amoxicillin clavulanate]] 875/125 mg bid {{or}} [[Doxycycline]] {{or}} [[Erythromycin]] {{or}} [[Clarithromycin]] {{or}} [[Linezolid]] {{or}} [[Fluoroquinolone]] {{or}} combinations for at least 6 months


==References==
==References==
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{{WS}}
[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Infectious Disease Project]]

Latest revision as of 18:11, 18 September 2017

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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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