Mycobacterium abscessus medical therapy

Mycobacterium Abscessus Microchapters
Home
Patient Information
Overview
Historical Perspective
Causes
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
Other Imaging Findings
Treatment
Medical Therapy
Surgery
Primary Prevention
Case Studies
Case #1
Mycobacterium abscessus medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Mycobacterium abscessus medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Mycobacterium abscessus medical therapy
CDC on Mycobacterium abscessus medical therapy
Mycobacterium abscessus medical therapy in the news
Blogs on Mycobacterium abscessus medical therapy
Directions to Hospitals Treating Mycobacterium abscessus
Risk calculators and risk factors for Mycobacterium abscessus medical therapy

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

• 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