Malakoplakia Treatment & Management

Updated: Apr 16, 2019
  • Author: Amira M Elbendary, MBBCh, MSc; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

Generally, cutaneous malakoplakia is treated in an outpatient setting. Therapy with antibiotics that concentrate in macrophages (eg, quinolone, trimethoprim-sulfamethoxazole) is associated with a high cure rate. [47] Antibiotic therapy directed against E coli in combination with surgery provides the best chance of cure.

Bethanechol, a choline agonist, has been used in combination with antibiotics and surgery. Bethanechol may correct the decreased cGMP levels that are believed to interfere with complete bacterial killing. [48]

Ascorbic acid has been used to increase the cGMP and cyclic adenosine monophosphate (cAMP) levels in monocytes, which may represent an effective strategy for therapy. An insufficient number of patients have been treated with ascorbic acid to determine its overall effect. [48]

Discontinuation of immunosuppressive drug therapy is usually needed to effectively treat malakoplakia. [49]  However, it was reported that sustained antimicrobial therapy together with reduction of immunosuppression may be appropriate for treating malakoplakia with reduction of the risk of poor graft survival in patients taking immunosuppression following renal transplantation.

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Surgical Care

Excision of skin lesions and drainage of abscesses are fundamental to diagnosis and treatment. Surgery combined with antibiotic therapy should be directed against E coli or other organisms recovered on culture.

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Consultations

Consultation with a dermatologist and/or an infectious disease specialist may be necessary.

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Prevention

Patients should notify the physician if they develop a chronic skin lesion. Immunosuppressive agents should be used with caution in patients with a prior history of malakoplakia.

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Long-Term Monitoring

Patients should receive follow-up observation until the skin lesions resolve clinically. Patients may require a prolonged course of antibiotic therapy.

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