What is the antibiotic coverage for Mycobacterium intracellulare (Mycobacterium intracellulare) infection?

From the Guidelines

The recommended antibiotic coverage for Mycobacterium intracellulare infection includes a macrolide, such as clarithromycin or azithromycin, in combination with ethambutol, with or without rifabutin, as the cornerstone of therapy. This recommendation is based on the most recent and highest quality study available, which suggests that initial treatment of MAC disease should consist of two or more antimycobacterial drugs to prevent or delay the emergence of resistance 1. The use of a macrolide, such as clarithromycin or azithromycin, is recommended as the first agent, with ethambutol as a second drug, due to their effectiveness in targeting different aspects of mycobacterial metabolism and cell wall synthesis.

Some key points to consider when treating Mycobacterium intracellulare infections include:

• The importance of using a multidrug regimen to prevent or delay the emergence of resistance 1
• The use of clarithromycin or azithromycin as the cornerstone of therapy, due to their ability to inhibit protein synthesis 1
• The addition of ethambutol, which disrupts cell wall formation, as a second drug 1
• The potential use of rifabutin, which inhibits RNA synthesis, as a third drug 1
• The importance of regular monitoring for drug toxicities, including visual testing for ethambutol, liver function tests for rifampin, and audiometry for aminoglycosides.

It is also important to note that alternative regimens may be necessary for patients with macrolide resistance, and that the treatment duration is typically 12 months after culture conversion, which usually means 18-24 months total therapy. Overall, the goal of treatment is to improve morbidity, mortality, and quality of life for patients with Mycobacterium intracellulare infections, and to prevent or delay the emergence of resistance to antimycobacterial agents.

From the FDA Drug Label

Since concentrations of 14-OH clarithromycin are significantly reduced when clarithromycin is co-administered with atazanavir, alternative antibacterial therapy should be considered for indications other than infections due to Mycobacterium avium complex. Etravirine: Clarithromycin exposure was decreased by etravirine; however, concentrations of the active metabolite, 14-OH-clarithromycin, were increased Because 14-OH-clarithromycin has reduced activity against Mycobacterium avium complex (MAC), overall activity against this pathogen may be altered; therefore alternatives to clarithromycin should be considered for the treatment of MAC

The antibiotic coverage for Mycobacterium intracellulare infection is not directly addressed in the provided text, but Mycobacterium avium complex (MAC) is mentioned, which includes Mycobacterium intracellulare.

• Clarithromycin is used to treat MAC, but its effectiveness may be altered when co-administered with certain drugs.
• Alternative antibacterial therapy should be considered for indications other than infections due to MAC.
• The provided text does not give a clear answer to the question of antibiotic coverage for Mycobacterium intracellulare infection, but it implies that clarithromycin may be used to treat it, with certain precautions 2.

From the Research

Antibiotic Coverage for Mycobacterium intracellulare Infection

The following antibiotics have been studied for their effectiveness against Mycobacterium intracellulare infection:

• Macrolides, such as clarithromycin 3, 4, 5 and azithromycin 3, 6, 5
• Ethambutol 3, 6, 5, 7
• Clofazimine 3, 5, 7
• Rifamycins, such as rifabutin 5 and rifampin 5
• Aminoglycosides, such as amikacin 5, 7 and streptomycin 7
• Fluoroquinolones, such as ciprofloxacin 5
• Bedaquiline 7
• Linezolid 7

Treatment Regimens

Recommended treatment regimens for Mycobacterium intracellulare infection include:

• A macrolide-containing three-drug regimen 6
• A combination of clarithromycin or azithromycin with ethambutol and clofazimine 3
• Multidrug therapy to maximize efficacy and minimize the emergence of resistance 5

Resistance Rates

The resistance rates of Mycobacterium intracellulare to various antibiotics have been studied, with results showing:

• Low resistance rates to clarithromycin, amikacin, bedaquiline, rifabutin, streptomycin, and clofazimine 7
• High resistance rates to isoniazid, rifampin, linezolid, doxycycline, and ethionamide 7
• Significant differences in resistance rates between M. avium and M. intracellulare for certain antibiotics, such as ethambutol and amikacin 7