Mycobacterium abscessus medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The treatment of | 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== | ||
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The treatment of ''M. abscessus'' includes the following: | 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> | ||
====Antibiotic Regimen==== | ====Antibiotic Regimen==== | ||
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===Pulmonary Infection=== | ===Pulmonary Infection=== | ||
The treatment of pulmonary ''M. abscessus'' infection includes: | The treatment of pulmonary ''M. abscessus'' infection includes: | ||
* A | * 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> | * 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> | ||
Revision as of 13:57, 24 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
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
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.