From the Guidelines
I would not recommend using omadacycline alone to treat nontuberculous mycobacterial (NTM) infections. NTM infections typically require combination antibiotic therapy with multiple drugs for extended periods, often 12-18 months or longer. The standard treatment regimens for common NTM infections like Mycobacterium avium complex (MAC) usually include a macrolide (clarithromycin or azithromycin), ethambutol, and a rifamycin (rifampin or rifabutin) 1. For M. abscessus, treatment might include a macrolide, amikacin, and combinations of other antibiotics like imipenem, cefoxitin, or tigecycline 1. While omadacycline is a tetracycline-class antibiotic with broad-spectrum activity, it has limited clinical evidence supporting its use as a primary agent for NTM infections. Tetracyclines are sometimes used as part of combination therapy for certain NTM species, but they're not typically first-line agents. Treatment for NTM should be guided by species identification, in vitro susceptibility testing, the site and severity of infection, and should be managed by specialists experienced in treating these complex infections. Side effects and drug interactions must also be carefully monitored throughout the extended treatment course.
Some key considerations in treating NTM infections include:
- The need for combination therapy to effectively treat the infection
- The importance of species identification and in vitro susceptibility testing to guide treatment
- The potential for drug interactions and side effects, particularly with long-term treatment
- The need for careful monitoring of treatment response and adjustment of the treatment regimen as needed
It's also important to note that the treatment of NTM infections can be complex and requires a comprehensive approach, taking into account the patient's overall health, the severity of the infection, and the potential risks and benefits of treatment 1.
In general, the treatment of NTM infections should be individualized and based on the specific needs and circumstances of each patient. A multidisciplinary approach, including input from specialists in infectious diseases, pulmonary medicine, and other relevant fields, is often necessary to ensure optimal treatment outcomes.
From the Research
Omadacycline for Nontuberculous Mycobacterial (NTM) Infections
- Omadacycline, a tetracycline class-derived aminomethylcycline, has shown promise in treating NTM infections, including those caused by Mycobacterium abscessus [(2,3,4,5,6)].
- Studies have demonstrated the in vitro potency of omadacycline against various NTM species, including M. abscessus, with MIC50 ranges of 0.004 to 0.25 and 0.06 to 1 μg/ml for 80% and 100% inhibition, respectively 5.
- Clinical trials and case series have reported positive outcomes with omadacycline treatment, including improved clinical success rates and tolerability [(2,3)].
- Omadacycline has been granted orphan drug designation by the US Food and Drug Administration for the treatment of pulmonary NTM infections, including M. abscessus [(2,6)].
Efficacy and Safety of Omadacycline
- A multicenter retrospective study found that 80.0% of patients with NTM infections achieved clinical success with omadacycline treatment, with adverse effects occurring in 32.0% of patients 3.
- In vitro and in vivo studies have demonstrated the efficacy of omadacycline against M. abscessus, including synergism with other antibiotics and concentration-dependent activity [(4,5)].
- Omadacycline has been shown to be effective against M. abscessus strains resistant to other antibiotics, making it a potential option for treatment [(4,5)].
Considerations for Use
- Omadacycline is not currently approved for the treatment of NTM infections, and its use is still considered off-label [(2,6)].
- Further research, including clinical trials, is needed to fully establish the effectiveness and safety of omadacycline for NTM infections [(5,6)].
- Healthcare providers should carefully consider the potential benefits and risks of omadacycline treatment for individual patients with NTM infections [(2,3,6)].