Sandbox sc

Mycobacterium terrae

• Mycobacterium terrae

• 1. In vitro susceptibility

• All six of the isolates from a single center and 90% or more of an additional 22 isolates of M. terrae complex were susceptible to Ciprofloxacin and Sulfonamides. Recently, 11 isolates of M. terrae complex were also shown to be susceptible to Linezolid

• 2. Antimicrobial therapy

• Preferred regimen: Macrolide AND Ethambutol or other agent based on in vitro susceptibility results

Mycobacterium szulgai

• Mycobacterium szulgai

• 1. in vitro susceptibility

• M. szulgai is susceptible in vitro to most antituberculous drugs including Quinolones and newer Macrolides.

• 2. Pulmonary infection

• Preferred regimen: three- or four-drug regimen based on susceptibility that includes 12 months of negative sputum cultures while on therapy

• 3. Extrapulmonary infection

• Preferred regimen: combination anti-tuberculous medications based on in vitro susceptibilities for 4 to 6 months

Mycobacterium smegmatis

• Mycobacterium smegmatis

• 1. Mild disease

• Preferred regimen: Doxycycline PO AND Trimethoprim sulfamethoxazole PO

• 2. Severe disease

• Preferred regimen: Amikacin IV OR Imipenem IV

Mycobacterium mucogenicum

• Mycobacterium mucogenicum

• In vitro susceptible agents: Aminoglycosides, Cefoxitin, Clarithromycin, Minocycline, Doxycycline, Quinolones, Trimethoprim/sulfamethoxazole, and Imipenem

Mycobacterium malmoense

• Mycobacterium malmoense

• in vitro

• Susceptible: Ethambutol, Ethionamide, Kanamycin, and Cycloserine
• Resistant: INH, Streptomycin, Rifampin, and Capreomycin

• Pulmonary M. malmoense infection

• Preferred regimen: INH AND Rifampin AND Ethambutol ± Quinolones AND Macrolides

Mycobacterium immunogenum

• Mycobacterium immunogenum

• In vitro

• susceptible: Amikacin AND Clarithromycin but
• resistant: Ciprofloxacin, Doxycycline, Cefoxitin, Tobramycin, and Sulfamethoxazole
• NOTE: The optimal therapy for this organism is unknown; however, successful therapy is likely difficult due to the extensive antibiotic resistance of the organism