Mycobacterium abscessus medical therapy: Difference between revisions
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====Antibiotic Regimen==== | ====Antibiotic Regimen==== | ||
In case of serious skin, soft tissues, and bones infection, a combination of antibiotics need to be administered: | In case of serious skin, soft tissues, and bones infection, a combination of antibiotics need to be administered:<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> | ||
* [[Macrolide]]: [[clarithromycin]] ''OR'' [[azithromycin]] | * [[Macrolide]]: [[clarithromycin]] ''OR'' [[azithromycin]] | ||
''PLUS'' | ''PLUS'' | ||
* Parenteral antibiotics: [[amikacin]] ''OR'' [[cefoxitin]] ''OR'' [[imipenem]] | * Parenteral antibiotics: [[amikacin]] ''OR'' [[cefoxitin]] ''OR'' [[imipenem]] | ||
Note that, during the initial therapy, [[amikacin]] should be administered with [[cefoxitin]] up to two weeks or until the patient improves clinically. | Note that, during the initial therapy, [[amikacin]] should be administered with [[cefoxitin]] up to two weeks or until the patient improves clinically.<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> | ||
====Antibiotic Dosage==== | ====Antibiotic Dosage==== | ||
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| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |Antibiotic ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |Dosage | | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |Antibiotic ||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |Dosage | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Clarithromycin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |1,000 mg/day | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Clarithromycin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |1,000 mg/day<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> | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Azithromycin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | 250 mg/day | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Azithromycin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | 250 mg/day<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> | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Amikacin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Amikacin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | | ||
| Line 36: | Line 36: | ||
''Three times per week regimen'' <br> | ''Three times per week regimen'' <br> | ||
- 25 mg/kg | - 25 mg/kg<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> | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Cefoxitin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | High dose, up to 12 g/day, divided dose | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Cefoxitin]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | High dose, up to 12 g/day, divided dose<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> | ||
|- | |- | ||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Imipenem]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | 500 mg, 2-4 times/day | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Imipenem]]||style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | 500 mg, 2-4 times/day<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> | ||
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|} | |} | ||
====Antibiotic Duration of Therapy==== | ====Antibiotic Duration of Therapy==== | ||
* [[Skin or soft tissue infection]]: At least 4 months | * [[Skin or soft tissue infection]]: At least 4 months<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> | ||
* [[Bone]] infection: 6 months | * [[Bone]] infection: 6 months<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=== | ===Pulmonary Infection=== | ||
Revision as of 20:03, 23 July 2014
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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
Medical Therapy
Skin and Soft Tissue Infections
The treatment of mycobacterium abscessus include 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
- Administration of combination of antibiotics for a prolonged period of time: clarithromycin 1,000 mg/day based regimen[1]
- A combination of antibiotics is indicated for the treatment of pulmonary infection with mycobacterium abscessus; however, there is no evidence on the optimal multidrug regimen.
- Surgical resection of the localized disease[1]
- Surgical resection and multidrug antibiotic therapy is associated with a higher chance of a successful treatment.
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 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.