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Dermatologic Manifestations of Mycobacterium Marinum Infection of the Skin Medication

  • Author: Joslyn S Kirby, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Apr 16, 2014

Medication Summary

The mainstay of therapy for infection by M marinum is antimicrobials, including antibiotics and antimycobacterials.

The organism is generally sensitive to rifampin plus ethambutol, tetracyclines (minocycline [MCN],[27] doxycycline [DCN]), trimethoprim-sulfamethoxazole (TMP-SMZ), clarithromycin,[28] and fluoroquinolones (ciprofloxacin, ofloxacin, sparfloxacin). Resistance to doxycycline and rifampin has been reported but is rare.[29, 30]

Antimicrobials are administered singly or in combination.[24] Single-agent therapy may be sufficient in uncomplicated infection of the skin; however, combination therapy is used when more extensive infection is treated. Combination antimycobacterial agents include the following:

  • Rifampin and ethambutol: This combination is regarded as highly effective therapy, especially for severe disease or in patients with impaired immune systems.
  • Streptomycin, ethambutol, and isoniazid
  • Clarithromycin, alone or in combination: This agent has shown the most efficacy of the macrolide antibiotics. One case report discusses the use of azithromycin in combination with ethambutol. Erythromycin has not demonstrated efficacy for treating M marinum infections.

Combining rifabutin or rifampin with macrolide antibiotics is not recommended because of the decreased efficacy of the macrolide and the increased levels of rifabutin or rifampin.

Most strains of M marinum have been found to be resistant to medications typically used for Mycobacterium tuberculosis, including isoniazid, streptomycin, pyrazinamide, and para-aminosalicylic acid.[22] In contrast, ethambutol is effective in combination with antimycobacterial or antibiotics, but not as a single agent.

The duration of therapy is empiric; multiple sources recommend extended therapy for 4-6 weeks following clinical resolution of lesions.[24]


Antimicrobial agents

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Therapy must be taken regularly and continued for a sufficient period.

Rifampin (Rifadin, Rimactane)


Found to be effective as monotherapy and is successful when given in combination with another antimicrobial. Inhibits DNA-dependent bacterial RNA but not mammalian RNA polymerase. Cross-resistance may occur.

Ethambutol (Myambutol)


Only effective when combined with another antimicrobial agent, preferably rifampin. Diffuses into actively growing mycobacterial cells (eg, tubercle bacilli). Impairs cell metabolism by inhibiting synthesis of one or more metabolites, which, in turn, causes cell death. No cross-resistance demonstrated. Mycobacterial resistance is common with previous therapy.

Minocycline (Dynacin, Minocin) or Doxycycline (Doryx, Vibramycin)


Effective monotherapy; however, strains of M marinum resistant to doxycycline but sensitive to minocycline have been reported. Also treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma species.

Trimethoprim and sulfamethoxazole (Bactrim, Septra)


Several case reports have shown effectiveness of this drug. Reports indicate that it can help eradicate organisms unresponsive to either antituberculars or tetracyclines. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.

Clarithromycin (Biaxin)


Cases of organisms resistant to conventional antitubercular therapy have responded to clarithromycin but not erythromycin. Use of azithromycin has not been reported. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Has bactericidal activity against atypical Mycobacterium species (eg, M marinum).

Ciprofloxacin (Cipro)


Fluoroquinolones are effective alone or in combination with other medications to eradicate M marinum. Inhibits bacterial DNA synthesis and, consequently, growth.

Levofloxacin (Levaquin)


For treatment of tuberculosis and some atypical mycobacterial infections in combination with rifampin and other antituberculosis agents.

Contributor Information and Disclosures

Joslyn S Kirby, MD Assistant Professor, Department of Dermatology, Milton S Hershey Penn State Medical Center

Joslyn S Kirby, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, International Society for Cutaneous Lymphomas, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.


S Alison Basak, MD, MA Resident Physician, Department of Dermatology, Penn State Hershey Medical Center

S Alison Basak, MD, MA is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Pennsylvania Medical Society, Women's Dermatologic Society, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.


Ellen J Kim, MD Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania

Ellen J Kim, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Dermatology Foundation, Medical Dermatology Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Saeed Jaffer, MD, MS Assistant Clinical Professor, University of California at Los Angeles School of Medicine; Consulting Staff, Boston Dermatology

Saeed Jaffer, MD, MS is a member of the following medical societies: American Academy of Dermatology and American Society for MOHS Surgery

Disclosure: Nothing to disclose.

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Photograph of Mycobacterium marinum infection lesions.
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