Mycobacterium abscessus medical therapy

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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
• Administration of combination of antibiotics for a prolonged period of time (macrolide based regimen)

Pulmonary Infection

The treatment of pulmonary M. abscessus infection includes:

• Administration of combination of antibiotics for a prolonged period of time (macrolide based regimen)
• Surgical resection of the localized disease

Treatment

Antimicrobial regimen

• 1.Limited, localized extrapulmonary disease

• Preferred regimen: Clarithromycin 500 mg PO bid ± 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