Mycobacterium abscessus medical therapy: Difference between revisions
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==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. | |||
==Medical Therapy== | ==Medical Therapy== | ||
===Skin and Soft Tissue Infections=== | ===Skin and Soft Tissue Infections=== | ||
The treatment of | The treatment of ''M. abscessus'' includes the following: | ||
* Draining collections of pus | * Draining collections of pus | ||
* 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 | * 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> | ||
=== | ===Pulmonary Infection=== | ||
The treatment of pulmonary ''M. abscessus'' infection includes: | |||
* [[ | * 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> | ||
* 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> | |||
* | |||
==Treatment== | |||
*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> | |||
:* 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 | |||
:* 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== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Acid fast bacilli]] | [[Category:Acid fast bacilli]] | ||
[[Category:Nontuberculous mycobacteria]] | [[Category:Nontuberculous mycobacteria]] | ||
[[Category:Infectious Disease Project]] | |||
Latest revision as of 18:08, 18 September 2017
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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:
- Draining collections of pus
- Surgical debridement[1]
- Administration of combination of antibiotics for a prolonged period of time (macrolide based regimen)[1]
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
- 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
- ↑ 1.0 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.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.