Atypical Mycobacterial Diseases Medication

Updated: Nov 12, 2019
  • Author: Erisa Alia, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

When possible, sensitivity testing should be performed to guide the selection of drugs and optimize the therapy outcome. Treatment requires good adherence to potentially toxic drug regimens over a prolonged period.

Tigecycline was administered in a 2014 series of 52 patients with M abscessus and M chelonae infections resistant to standard regimens. These patients received tigecycline for at least a month as part of a multidrug regimen. [88] Improvement was seen in more than 60% of patients, even those with underlying cystic fibrosis, regardless of failure of prior antibiotic therapy. The authors of this study noted adverse events in more than 90% of cases, with nausea and vomiting being the most common adverse effects.

Bedaquiline is approved by the US Food and Drug Administration (FDA) for macrolide-resistant, multidrug-resistant, and extremely drug-resistant tuberculosis. It has in vitro activity against M avium complex, M abscessus, and M ulcerans, making it a potential alternative agent for the treatment of pulmonary NTM disease. [89]

Delamanid is a dihydro-nitroimidazooxazole derivative that inhibits mycolic acid synthesis. The molecule is approved in Europe, Japan, and South Korea for multidrug-resistant tuberculosis. Delamanid has shown some in vitro inhibitory activity against M kansasii and other slow-growing mycobacteria. [90] More experience is needed to firmly establish its efficacy and safety in treatment of nontuberculous mycobacteria (NTM) infections.

Regarding oxazolidinones, both linezolid and tedizolid are active against NTM, but prolonged use of linezolid is associated with myelosuppression and neuropathies. Tedizolid is emerging as a more tolerable alternative to linezolid. [91] Newer members of the class, such as sutezolid, contezolid, and delpazolid, are currently in clinical trials for activity against M tuberculosis. [92]

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Antimycobacterial Agents

Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

Isoniazid (Nydrazid, Laniazid)

Isoniazid is used in isolation for prevention of tuberculosis and in combination to treat tuberculosis and mycobacterial infections.

Clarithromycin (Biaxin)

Clarithromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Streptomycin

Streptomycin is used in combination with other drugs in the treatment of M avium-intracellulare infections.

Ciprofloxacin (Cipro)

Ciprofloxacin is used in combination with other agents in the treatment of M avium-intracellulare infections.

Rifabutin (Mycobutin)

Rifabutin is used for the prevention of disseminated M avium-intracellulare infections in patients with HIV infection.

Minocycline (Dynacin, Minocin)

Minocycline treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma species and atypical mycobacteria.

Amikacin (Amikin)

Amikacin is used for gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin. It is effective against Pseudomonas aeruginosa. It irreversibly binds to the 30S subunit of bacterial ribosomes, blocks the recognition step in protein synthesis, and causes growth inhibition. Use ideal body weight of the patient for dosage calculation.

Cefoxitin (Mefoxin)

Cefoxitin is a second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin. Higher doses are required for severe or serious infections.

Bedaquiline (Sirturo)

It is a novel oral agent that inhibits ATP synthase with bactericidal activity against M tuberculosis. It is approved by the FDA for macrolide-resistant, multidrug-resistant, and extremely drug-resistant tuberculosis. It has in vitro activity against M avium complex, M abscessus, and M ulcerans, making it a potential alternative agent for the treatment of pulmonary NTM disease.

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