Nocardiosis Treatment & Management

Updated: Jul 24, 2018
  • Author: George Kurdgelashvili, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Medical Care

Protracted specific antimicrobial therapy is the mainstay of medical care for nocardiosis. Therapy is generally recommended for at least 6 months. [1]

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

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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.

In patients with nocardial brain abscesses, surgery should be performed if the lesions are large, if they are readily accessible, or if they progress beyond 2 weeks of antimicrobial therapy. [11]

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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.

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Diet

No specific dietary recommendations are warranted.

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Activity

Activity can be as tolerated by the patient.

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Prevention

Although not clearly established, prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP) with TMP-SMX in patients with AIDS whose CD4 count is less than 200 cells/µL probably decreases the likelihood of nocardiosis. (For an excellent discussion of PCP prophylaxis, see the Medscape Reference article Preventing Opportunistic Infections in Patients With HIV.) Similarly, TMP-SMX prophylaxis in solid-organ transplant or hematopoietic stem cell transplant recipients may decrease the likelihood of nocardiosis. However, prophylaxis is not fully effective in either circumstance.

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Inpatient & Outpatient Medications

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. 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 to monitor treatment.

Follow-up laboratory studies are required to monitor for adverse effects of prolonged antimicrobial therapy.

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