Pediatric Nocardiosis Treatment & Management

Updated: Oct 04, 2013
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Treatment

Medical Care

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  • Sulfa-based therapy is recommended for nocardiosis. Trimethoprim-sulfamethoxazole (Bactrim) or a sulfonamide (sulfadiazine), given intravenously in high doses, is the treatment of choice. [10]
  • Linezolid has a growing literature in support of its use in combination and even monotherapy for treatment of Nocardia infections. It has good CNS penetration, is available in an oral form, and is the only antibiotic known to be active against all strains of Nocardia.
  • Additional concurrent therapy with an aminoglycoside (amikacin, gentamicin) plus ceftriaxone benefits patients with fulminant disease.
  • Other medications for the pediatric age group include extended-spectrum cephalosporins, imipenem/meropenem, ampicillin, and amoxicillin-clavulanate. Tetracycline derivatives used in treatment include minocycline or doxycycline (in a child >8 y with sulfa hypersensitivity).
  • Patients who are immunocompetent with lymphocutaneous disease are usually treated for 6-12 weeks. Therapy includes incision and drainage of abscesses. Patients with immunocompromising conditions are treated for at least 3 months after clinical cure (usually up to 1 y of therapy).
  • Closely monitor patients with AIDS and CNS disease; relapse can occur years after therapy.
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Surgical Care

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  • Surgical therapy to drain abscesses is usually helpful (and potentially diagnostic); however, brain abscesses may respond to antimicrobial treatment without surgery. The risks of an invasive neurosurgical procedure should be balanced against the benefits of a diagnostic biopsy or potentially therapeutic drainage.
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Consultations

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  • A multidisciplinary team in a pediatric ICU setting should manage fulminant nocardiosis.
  • Consultation with a pediatric infectious diseases specialist is also recommended.
  • Neurosurgery or interventional radiology may need to be consulted to obtain biopsies.
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