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 variable in vitro drug susceptibilities profile; therefore, antibiotic susceptibility testing is required. M. abscessus infection is treated by a macrolide based multidrug antibiotic regimen.

Medical Therapy

Skin and Soft Tissue Infections

The treatment of mycobacterium 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]

Macrolide: clarithromycin OR azithromycin

PLUS

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.^[1]

Antibiotic Dosage

Antibiotic	Dosage
Clarithromycin	1,000 mg/day^[1]
Azithromycin	250 mg/day^[1]
Amikacin	Once a day regimen - Adults <50 years and normal renal function: 10-15 mg/kg - Age >50 years and/or anticipated long term therapy for more than 3 weeks: 10 mg/kg Three times per week regimen - 25 mg/kg^[1]
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.

Template:WikiDoc Sources

[pmid17277290-1] 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.

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