From the Guidelines
Mycobacterium chelonae treatment should include a combination of antibiotics, with clarithromycin being a key component, due to its high susceptibility rate of 100% 1. The treatment approach for M. chelonae infections varies depending on the site and severity of the disease.
- For skin, bone, and soft tissue disease, a minimum of 4 months of combination drug therapy is necessary, with clarithromycin and another agent, such as tobramycin or linezolid, being potential options 1.
- For bone infections, 6 months of therapy is recommended 1.
- Surgery is generally indicated with extensive disease, abscess formation, or where drug therapy is difficult, and removal of foreign bodies is important for recovery 1.
- For corneal infections, first-line treatment often involves topical and oral agents, such as amikacin, fluoroquinolones, clarithromycin, and azithromycin, depending on the in vitro susceptibility of the organism 1.
- The optimal therapy for M. chelonae lung disease is unknown, but a regimen including clarithromycin with a second agent, based on in vitro susceptibilities, would likely be successful with a treatment duration that includes 12 months of negative sputum cultures 1. It is essential to note that M. chelonae is resistant to many antibiotics, and treatment success depends on early diagnosis, appropriate antimicrobial selection, and addressing any underlying source of infection 1.
From the Research
Mycobacterium chimaera Treatment
- Mycobacterium chimaera is a slow-growing nontuberculous Mycobacterium species that can cause respiratory infections, cardiovascular infections, and other diseases 2.
- The optimal antibiotic treatment regimen for M. chimaera infections is not well established, but studies have shown that clarithromycin, amikacin, rifabutin, and streptomycin have good activity against M. chimaera isolates 2.
- Other antibiotics such as moxifloxacin and linezolid have lower susceptibility rates against M. chimaera 2.
- An open drug discovery approach has identified new inhibitory compounds and drug repurposing opportunities for M. chimaera, including MMV675968, oxazolidinones, and bedaquiline 3.
- Doxycycline, a broad-spectrum antimicrobial drug, has also been shown to inhibit M. chimaera with a mean MIC of 6.25 μg/mL 3.
- The treatment of M. chimaera infections often requires a combination of antibiotics and may need to be tailored to the individual patient based on drug susceptibility testing results 4.
- The duration of treatment for M. chimaera infections can vary depending on the severity of the disease and the patient's response to treatment, but it is often prolonged, lasting several months or even years 5.
Antibiotic Susceptibility
- Clarithromycin has been shown to be effective against M. chimaera, with a median MIC of 2 μg/mL 2.
- Amikacin is also effective against M. chimaera, with 98% of isolates susceptible to the antibiotic 2.
- Rifabutin and streptomycin have also been shown to be effective against M. chimaera, although the susceptibility rates are lower than for clarithromycin and amikacin 2.
- Moxifloxacin and linezolid have lower susceptibility rates against M. chimaera, with 25% and 39% of isolates having intermediate susceptibility, respectively 2.
Treatment Approaches
- The treatment of M. chimaera infections often requires a combination of antibiotics, including clarithromycin, amikacin, rifabutin, and streptomycin 2.
- Surgery may be necessary in some cases, particularly for patients with cardiovascular infections or other complications 4.
- The duration of treatment for M. chimaera infections can vary depending on the severity of the disease and the patient's response to treatment, but it is often prolonged, lasting several months or even years 5.