From the Guidelines
The recommended treatment for Nocardia infections is trimethoprim-sulfamethoxazole (TMP-SMX) as the first-line agent, with a treatment duration of 6-24 months, depending on the presence of disseminated disease and the extent of the patient's underlying immunosuppression. According to the 2014 update by the Infectious Diseases Society of America 1, TMP-SMX remains the treatment of choice for Nocardia infections. The dosage and treatment duration may vary depending on the severity of the infection and the patient's immune status. Some key points to consider in the treatment of Nocardia infections include:
- Combination therapy with other agents, such as amikacin, imipenem, or third-generation cephalosporins, should be considered in patients with severe infections or profound and lasting immunodeficiency 1.
- Prolonged therapy is important to prevent relapse, and the duration of treatment should take into account the presence of disseminated disease and the extent of the patient's underlying immunosuppression 1.
- Surgical debridement is recommended for necrotic nodules or large subcutaneous abscesses 1.
- Alternative antibiotics, such as minocycline, linezolid, or dapsone, may be effective in patients with sulfa allergies or resistance 1. It is essential to monitor treatment response with clinical assessment and follow-up imaging, and to adjust treatment based on culture results, as Nocardia species can vary in antibiotic susceptibility 1.
From the Research
Nocardia Treatment Overview
- Nocardia infections are rare and often difficult to treat, with no consensus on management 2.
- The preferred method for antibiotic susceptibility testing (AST) is broth microdilution, and molecular biology is the reference standard for Nocardia species identification 2.
Recommended Treatment
- Trimethoprim-sulfamethoxazole (TMP-SMZ) is the preferred agent for initial therapy, as Nocardia is often susceptible to this agent 2, 3, 4.
- Linezolid may be an alternative, as Nocardia is almost always susceptible to this agent 2.
- Monotherapy is suitable for patients with primary skin nocardiosis or non-severe pulmonary disease, while a multidrug regimen is reserved for more severe infections 2.
- Combination therapy may include third-generation cephalosporins, amikacin, and imipenem 2, 5.
Treatment Duration and Prophylaxis
- The recommended treatment duration is 6 months for most situations, but longer durations may be necessary for disseminated nocardiosis and shorter durations for low-risk situations 2.
- Secondary prophylaxis may be considered in selected individuals with permanent immunosuppression 2.