Mycobacterium abscessus medical therapy: Difference between revisions
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===Antimicrobial regimen=== | ===Antimicrobial regimen=== | ||
*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> | *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 (2): [[Amikacin]] {{and}} [[Imipenem]] 500 mg IV q6-8h for two weeks | :* 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''' | *2.'''Pulmonary or serious extrapulmonary disease''' | ||
:* Preferred regimen: [[Clarithromycin]] 500 mg PO | :* 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 | ||
:* Alternative regimen(1): [[Tigecycline]] 100 mg IV | :* 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(2): [[Linezolid]] 600 mg PO | :* 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== | ||
Revision as of 13:02, 27 July 2015
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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]
Antibiotic Regimen
In case of serious skin, soft tissues, and bones infection, a combination of antibiotics need to be administered:[1]
PLUS
Note that, during the initial therapy, amikacin should be administered with cefoxitin up to two weeks or until the patient improves clinically.[1]
Antibiotic Dosage
| Antibiotic | Dosage |
| Clarithromycin | 1,000 mg/day[1] |
| Azithromycin | 250 mg/day[1] |
| Amikacin |
Once a day regimen
|
| Cefoxitin | High dose, up to 12 g/day, divided dose[1] |
| Imipenem | 500 mg, 2-4 times/day[1] |
Antibiotic Duration of Therapy
- Skin or soft tissue infection: At least 4 months[1]
- Bone infection: 6 months[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]
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 antibiotics to be administered is:[1]
PLUS
PLUS
Note that, in case of macrolide resistance, the antibiotic therapy should be chosen based on the suscepibility profile of M. abscessus.
Duration of the Antibiotic Regimen
2-4 months
Treatment
Antimicrobial regimen
- 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
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 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.