From the Guidelines
The treatment for Mycobacterium chelonae infections should involve a combination of antibiotics, including clarithromycin, for at least 4-6 months, with the specific regimen guided by in vitro susceptibility testing, as recommended by the American Journal of Respiratory and Critical Care Medicine 1. The choice of antibiotics is crucial, and according to the study, isolates of M. chelonae are susceptible or intermediate in susceptibility to tobramycin, clarithromycin, linezolid, imipenem, amikacin, and others 1.
- Key considerations in the treatment of M. chelonae infections include:
- The use of clarithromycin as a cornerstone medication, given its excellent activity against this organism, with a recommended dose of 500 mg twice daily 1
- The addition of other antibiotics, such as amikacin, tobramycin, imipenem, linezolid, or fluoroquinolones, based on susceptibility testing 1
- The importance of surgical debridement, particularly for localized skin infections, abscesses, or infected foreign bodies, which should be removed when possible 1
- The need for extended treatment duration, generally 6-12 months, due to the natural resistance of M. chelonae to many conventional antibiotics 1
- It is essential to monitor patients for medication side effects, particularly with long-term use of clarithromycin or linezolid, and to adjust the treatment regimen as needed based on clinical response and susceptibility testing 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.
From the Research
Treatment Options for Mycobacterium chelonae Infections
- The treatment of Mycobacterium chelonae infections often involves the use of antimicrobial agents, with varying degrees of success 2, 3, 4, 5, 6.
- Traditional antituberculous drugs have been shown to have poor activity against M. chelonae, while aminoglycosides such as tobramycin and amikacin, macrolides like clarithromycin, and quinolones like ciprofloxacin have demonstrated better efficacy 2.
- Clarithromycin, in particular, has been found to be effective against M. chelonae, both in vitro and in clinical settings, and is often used as a single-drug regimen or in combination with other antibiotics 3, 4, 5, 6.
- The use of combination therapy, including fortified amikacin, clarithromycin, and a fourth-generation fluoroquinolone, has also been shown to be beneficial in treating M. chelonae infections, particularly in cases of post-LASIK keratitis 6.
- The duration of treatment for M. chelonae infections can be prolonged, and relapse may occur if the treatment is not long enough, especially in immunosuppressed patients 3.
Antimicrobial Agents Used to Treat Mycobacterium chelonae Infections
- Aminoglycosides: tobramycin, amikacin 2, 4, 6
- Macrolides: clarithromycin 2, 3, 4, 5, 6
- Quinolones: ciprofloxacin, gatifloxacin, levofloxacin 2, 6
- Beta-lactam antibiotics: imipenem 2
Considerations for Treatment
- The treatment of M. chelonae infections should be individualized based on the severity of the infection, the patient's immune status, and the results of antimicrobial susceptibility testing 2, 3, 4, 5, 6.
- Combination therapy may be necessary to achieve optimal results, and the use of fourth-generation fluoroquinolones may be beneficial in certain cases 6.
- Prolonged treatment duration and close monitoring for relapse are crucial in ensuring the successful treatment of M. chelonae infections 3.