eMedicine Specialties > Infectious Diseases > Mycobacterial Infections
Mycobacterium Xenopi: Treatment & Medication
Updated: May 12, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
A physician detecting a positive M xenopi culture result must differentiate among colonization, contamination, and true disease.
- Assess bacteriologic data (eg, repeated isolation, organism identification), clinical symptoms, and radiographic findings within the entire clinical context.
- Treat with chemotherapy, although optimal therapy is not well established.
Surgical Care
Surgery may be curative for patients who present with solitary pulmonary nodules and for those with localized pulmonary disease who fail to respond to, or who relapse after, chemotherapy.
Consultations
- Infectious disease specialist
- Thoracic surgery specialist
- Pulmonary medicine specialist
Diet
Patients do not require special diets.
Activity
Patients do not require activity restrictions.
Medication
Optimal therapy for M xenopi is not established. Response to therapy varies and does not always correlate with the results of in vitro susceptibility testing. Physicians use combination therapy, with 2-4 drugs prescribed from several months to up to 18 months. M xenopi disease should always be treated with at least 2 active drugs because single-drug therapy increases the probability of acquired resistance.
Antibiotics
Therapy must be comprehensive and cover all likely pathogens in the context of the clinical setting.
Clarithromycin (Biaxin)
Probably most important drug. To avoid development of resistance, should not be used as monotherapy. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Adult
500 mg PO bid
Pediatric
15 mg/kg PO divided bid
Toxicity increases with coadministration of fluconazole, astemizole, and pimozide; effects decrease and adverse GI effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, and HMG CoA-reductase inhibitors; serious cardiac arrhythmias may occur with coadministration of cisapride; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increased QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents
Documented hypersensitivity; coadministration of pimozide
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; administer half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies
Ethambutol (Myambutol)
Probably second most important drug. 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 frequent with previous therapy. Use in these patients in combination with second-line drugs that have not been administered previously. Administer q24h until permanent bacteriologic conversion and maximal clinical improvement is observed. Absorption is not altered significantly by food.
Adult
No previous antituberculous therapy: 15 mg/kg/d (7 mg/lb/d) PO; previous antituberculous therapy: 25 mg/kg/d (11 mg/lb/d)
Pediatric
<12 years: Not recommended
>12 years: Administer as in adults
Aluminum salts may delay and reduce absorption (administer several h before or after ethambutol dose)
Documented hypersensitivity; optic neuritis (unless clinically indicated)
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Reduce dose in impaired renal function; optic neuritis/color blindness with doses >15 mg/kg/d; obtain ophthalmology consult if 25 mg/kg/d dose used
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, administer dose bid with food.
Adult
300 mg PO qd is regular dose; maximum 600 mg/d PO; alternatively, 10-20 mg/kg/d; not to exceed 600 mg/d; if GI upset, administer dose bid with food
Pediatric
Not established; suggested dose, 5 mg/kg/d PO
Steady-state zidovudine plasma levels may decrease after repeated rifabutin dosing but do not affect inhibition of HIV by zidovudine
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Do not administer to patients with active tuberculosis; no evidence of effectiveness in preventing Mycobacterium tuberculosis infection; may administer isoniazid concurrently in patients requiring prophylaxis against both M tuberculosis and Mycobacterium avium complex; perform hematologic studies periodically in patients receiving prophylaxis because of association with neutropenia and, more rarely, thrombocytopenia
Streptomycin
For treatment of susceptible mycobacterial infections. Use in combination with other antituberculous drugs (eg, isoniazid, ethambutol, rifampin). Total period of treatment for tuberculosis is minimum of 1 y; however, indications for terminating therapy may occur at any time. Recommended when less potentially hazardous therapeutic agents are ineffective or contraindicated.
Adult
1 g IM qd
2 times/wk dosing: 15 mg/kg/d IM; not to exceed 1 g/d
3 times/wk dosing: 25-30 mg/kg/d IM; not to exceed 1.5 g/d
Pediatric
2 times/wk dosing: 20-40 mg/kg/d IM; not to exceed 1 g/d
3 times/wk dosing: 25-30 mg/kg/d IM; not to exceed 1.5 g/d
Increased toxicity with loop diuretics (eg, furosemide) and amphotericin B; increased prolonged effect depolarizing and nondepolarizing neuromuscular blocking agents
Documented hypersensitivity; non–dialysis-dependent renal insufficiency
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Monthly audiogram; narrow therapeutic index; not intended for long-term therapy; caution in patients with renal failure who are not on dialysis; caution with myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission
Rifampin (Rifadin)
Probably an important drug for treatment. For use in combination with at least 1 other antituberculous drug. Inhibits DNA-dependent bacteria but not mammalian RNA polymerase. Cross-resistance may occur.
Adult
10 mg/kg/d PO/IV; divided doses if patient is intolerant; not to exceed 600 mg/d; treat for 6-9 mo or until 6 mo elapse from conversion to negative sputum culture results
Pediatric
10-20 mg/kg PO/IV; not to exceed 600 mg/d
Induces microsomal enzymes, which may decrease effects of acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, oral contraceptives, corticosteroids, mexiletine, cyclosporine, digitoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, tocainide, and digoxin; blood pressure may increase with coadministration of enalapril; coadministration with isoniazid may result in higher rate of hepatotoxicity than with either agent alone (discontinue one or both agents if alterations in LFT findings occur)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Colors urine, sweat, tears, and contact lenses orange-brown; order pretreatment LFT (repeat if symptomatic); obtain CBC counts and baseline clinical chemistries prior to and throughout therapy; in liver disease, weigh benefits against risk of further liver damage; interruption of therapy and high-dose intermittent therapy are associated with thrombocytopenia that is reversible if therapy is discontinued
Azithromycin (Zithromax)
Similar to clarithromycin but may allow once-per-wk dosing.
Adult
250-500 mg/d PO for 5-14 d
1200 mg/d PO once-per-wk dosage has been used
Pediatric
<6 months: Not established
>6 months: 10 mg/kg PO on day 1, not to exceed 500 mg/d; 5 mg/kg/d PO on days 2-5, not to exceed 250 mg/d
May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Documented hypersensitivity; hepatic impairment; do not administer with pimozide
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function or prolonged QT intervals; caution in patients who are hospitalized, elderly, or debilitated
Levofloxacin (Levaquin)
For treatment of tuberculosis in combination with rifampin and other antituberculosis agents.
Adult
500-1000 mg/d PO
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 1-2 h ac or pc
Documented hypersensitivity; pregnancy; lactation
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose in renal function impairment
More on Mycobacterium Xenopi |
| Overview: Mycobacterium Xenopi |
| Differential Diagnoses & Workup: Mycobacterium Xenopi |
 Treatment & Medication: Mycobacterium Xenopi |
| Follow-up: Mycobacterium Xenopi |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
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Further Reading
Clinical guidelines
Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 2003 Jun 6. 42 pages. NGC:003059
Mycobacterial infections.
New York State Department of Health - State/Local Government Agency [U.S.]. 2005 May (revised 2006 Sep). 20 pages. NGC:006468
Clinical trials
Study of Mycobacterial Infections
Related eMedicine topics
Atypical Mycobacterial Diseases
Keywords
Mycobacterium xenopi, M xenopi, South African toad, Xenopus laevis, X laevis, nontuberculous mycobacterium, nontuberculous mycobacteria, mycobacteremia, leukocytosis, leucopenia, leukopenia, anemia, reactive thrombocytosis, thrombocytopenia, nontuberculous mycobacterial lung disease, pulmonary disease, cavitary apical pulmonary disease, multifocal bronchiectasis, granulomatous inflammation, acid-fast bacilli
