Nocardiosis Treatment & Management

Updated: Mar 09, 2021
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print
Treatment

Medical Care

Protracted specific antimicrobial therapy is the mainstay of medical care for nocardiosis. Therapy is generally recommended for at least 6 months, and at least 12 months for CNS infections. [1, 16]

In patients who require immunosuppressive therapy, such therapy can generally be continued while appropriate specific therapy for nocardiosis is administered.

Next:

Surgical Care

For lesions outside the CNS, surgical management is the same as standard recommendations for other infections; that is, localized abscesses generally require prompt surgical therapy. Pericarditis complicating pulmonary infection may be fatal and requires surgical drainage [31] .

In patients with nocardial brain abscesses, surgery should be performed if the lesions are large, readily accessible, or progressing beyond 2 weeks of antimicrobial therapy. [14]

Previous
Next:

Consultations

An infectious diseases specialist is recommended for coordinating protracted antimicrobial therapy. Depending on the infection site(s), consultation with a pulmonologist, thoracic surgeon, general surgeon, and/or neurosurgeon may be appropriate.

Previous
Next:

Diet

No specific dietary recommendations are warranted.

Previous
Next:

Activity

Activity can be as tolerated by the patient.

Previous
Next:

Prevention

Primary prevention is not routinely recommended for immunosuppressed individuals.

Patients at risk of Nocardia infection should be evaluated for reduction or cessation of immunosuppressive therapy. In patients with prior nocardiosis infections on immunosuppressive therapy which cannot be discontinued, secondary prophylaxis may be considered with daily double-strength trimethoprim-sulfamethoxazole (TMP-SMX). [38, 39]

While lower dose regimens of TMP-SMX are effective in preventing other opportunistic infections, such as Pneumocystis jiroveci pneumonia (PJP) (See the Medscape Reference article Preventing Opportunistic Infections in Patients With HIV) in immunocompromised patients, bi-and tri-weekly TMP-SMX regimens have not been sufficient in preventing Nocardia in high-risk patients. [38, 40]

Previous
Next:

Long-Term Monitoring

Antimicrobial therapy for pulmonary or disseminated nocardiosis should be continued for 6-12 months and at least 1 month following resolution of all evidence of infection. Patients should undergo follow-up monthly after discharge from the hospital and during antimicrobial therapy to ensure an appropriate response to therapy and monitor for medication adverse effects with laboratory studies. These patients require at least 12 months of monitoring after the completion of therapy to detect possible late relapses.

Follow-up radiographic studies should be obtained roughly every three months to monitor treatment. Examples include chest radiographs and CT-scans for patients with pulmonary disease and CT-brain or MRI for CNS disease. Radiographic studies are required after antimicrobial therapy has concluded to to ensure there is not evidence of relpase on imaging. 

 

Previous