Health Dictionary

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]

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]

Treatment

1.Limited, localized extrapulmonary disease ^[2]

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

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 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.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid17277290-1] 1.0 ^1.1 ^1.2 ^1.3 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.

[2] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

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