Mycobacterium gordonae Medication
- Author: Klaus-Dieter Lessnau, MD, FCCP; Chief Editor: Burke A Cunha, MD more...
Medication Summary
While the most effective treatment regimen has not been established, in vitro susceptibilities suggest clarithromycin and, possibly, azithromycin, quinolones (eg, levofloxacin, moxifloxacin), and ethambutol as treatment options. Rifabutin may be beneficial, and rifampin has shown variable results.
In vivo activity of doxycycline and trimethoprim-sulfamethoxazole is not known.
M gordonae has been shown to be resistant to isoniazid, pyrazinamide, and streptomycin.
The recommended duration of therapy is not established.
Antimycobacterials
Class Summary
Empiric antimycobacterial therapy must be comprehensive.
Clarithromycin (Biaxin)
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Very active drug for nontuberculous mycobacterial disease, but acquired resistance from monotherapy is a concern.
Ethambutol (Myambutol)
Standard drug for nontuberculous mycobacterial disease. Diffuses into actively growing mycobacterial cells and impairs cell metabolism by inhibiting synthesis of one or more metabolites, which, in turn, causes cell death. No cross-resistance demonstrated. Mycobacterial resistance is frequent with previous therapy. Use in these patients in combination with second-line drugs that have not previously been administered. Administer qd until permanent bacteriological conversion and maximal clinical improvement is observed. Absorption not significantly altered by food.
Levofloxacin (Levaquin)
May be useful. Aide effects are very rare (eg, GI or CNS abnormalities, tendinitis). For treatment of mycobacterial infection in combination with rifampin and other antituberculosis agents.
Rifampin (Rifadin, Rimactane)
For use in combination with at least one other antituberculous drug. Inhibits DNA-dependent bacterial but not mammalian RNA polymerase. Cross-resistance may occur. Often used for nontuberculous mycobacterial disease.
Rifabutin (Mycobutin)
Ansamycin antibiotic derived from rifamycin S. Inhibits DNA-dependent RNA polymerase, preventing chain initiation in susceptible strains of Escherichia coli and Bacillus subtilis but not in mammalian cells. If GI upset occurs, administer dose bid with food. May be more active with nontuberculous species.
Azithromycin (Zithromax)
Treats mild-to-moderate microbial infections. Dosing qwk is possible.
Lalande V, Barbut F, Varnerot A, Febvre M, Nesa D, Wadel S, et al. Pseudo-outbreak of Mycobacterium gordonae associated with water from refrigerated fountains. J Hosp Infect. May 2001;48(1):76-9. [Medline].
Yoshida S, Suzuki K, Iwamoto T, Tsuyuguchi K, Tomita M, Okada M, et al. [Detection of molecular epidemiology of Mycobacterium gordonae isolates]. Kekkaku. Jul 2010;85(7):609-14. [Medline].
American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med. Aug 1997;156(2 Pt 2):S1-25. [Medline].
Jun HJ, Jeon K, Um SW, Kwon OJ, Lee NY, Koh WJ. Nontuberculous mycobacteria isolated during the treatment of pulmonary tuberculosis. Respir Med. Dec 2009;103(12):1936-40. [Medline].
Konishi M, Uno K, Kasahara K, Mori K, Yoshimoto E, Maeda K, et al. [A case of pulmonary Mycobacterium gordonae infection progressed for no therapy]. Nihon Kokyuki Gakkai Zasshi. May 2007;45(5):436-40. [Medline].
Lessnau KD, Milanese S, Talavera W. Mycobacterium gordonae: a treatable disease in HIV-positive patients. Chest. Dec 1993;104(6):1779-85. [Medline].
Sneath PH, Mair NS, Sharpe ME, eds. The Mycobacteria. Genus Mycobacterium. In: Bergey's Manual of Systematic Bacteriology. Vol 2. 2nd ed. Baltimore, Md: Williams & Wilkins; 1986:1447.
Sánchez-Morgado JM, Gallagher A, Johnson LK. Mycobacterium gordonae infection in a colony of African clawed frogs (Xenopus tropicalis). Lab Anim. Jul 2009;43(3):300-3. [Medline].
Umeda Y, Matsuno Y, Imaizumi M, Mori Y, Iwata H, Takiya H. Extralobar pulmonary sequestration infected with Mycobacterium gordonae. J Thorac Cardiovasc Surg. Jan 2009;137(1):e23-4. [Medline].
Weinberger M, Berg SL, Feuerstein IM, Pizzo PA, Witebsky FG. Disseminated infection with Mycobacterium gordonae: report of a case and critical review of the literature. Clin Infect Dis. Jun 1992;14(6):1229-39. [Medline].
Print
