Sections

Sections Atypical Mycobacterial Diseases
Overview
Presentation
DDx
Workup
Treatment
Medication
References

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]

Class Summary

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

Isoniazid (Nydrazid, Laniazid)

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

Clarithromycin (Biaxin)

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

Streptomycin

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

Ciprofloxacin (Cipro)

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

Rifabutin (Mycobutin)

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

Minocycline (Dynacin, Minocin)

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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)

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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)

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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)

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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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Media Gallery

Mycobacterium marinum is an atypical mycobacteria found in water with a wide range of temperatures and salinities

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Author

Erisa Alia, MD Clinical Trials Research Fellow, Department of Dermatology, University of Connecticut School of Medicine

Erisa Alia, MD is a member of the following medical societies: Albanian Society of Dermatology and Venereology, European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Coauthor(s)

Jun Lu, MD, FAAD Associate Professor, Director of Clinical Trial Unit, Director of Connective Tissue Disease Multispecialty Clinic, Farmington Site Director of Dermatology Residency Program, Department of Dermatology, University of Connecticut Health Center

Jun Lu, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Telemedicine Association, Connecticut Society of Dermatology and Dermatologic Surgery, New England Dermatological Society, Rheumatologic Dermatology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

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.

Additional Contributors

Takeji Nishikawa, MD Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

Sections Atypical Mycobacterial Diseases
Overview
Presentation
DDx
Workup
Treatment
Medication
References

Atypical Mycobacterial Diseases Medication

Medication Summary

Antimycobacterial Agents

Class Summary

Isoniazid (Nydrazid, Laniazid)

Isoniazid (Nydrazid, Laniazid)

Clarithromycin (Biaxin)

Clarithromycin (Biaxin)

Streptomycin

Streptomycin

Ciprofloxacin (Cipro)

Ciprofloxacin (Cipro)

Rifabutin (Mycobutin)

Rifabutin (Mycobutin)

Minocycline (Dynacin, Minocin)

Minocycline (Dynacin, Minocin)

Amikacin (Amikin)

Amikacin (Amikin)

Cefoxitin (Mefoxin)

Cefoxitin (Mefoxin)

Bedaquiline (Sirturo)

Bedaquiline (Sirturo)

Atypical Mycobacterial Diseases Medication

Medication Summary

Antimycobacterial Agents

Class Summary

Isoniazid (Nydrazid, Laniazid)

Clarithromycin (Biaxin)

Streptomycin

Ciprofloxacin (Cipro)

Rifabutin (Mycobutin)

Minocycline (Dynacin, Minocin)

Amikacin (Amikin)

Cefoxitin (Mefoxin)

Bedaquiline (Sirturo)

References

Tables

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