What antibiotics are used to treat Corynebacterium spp. infections?

Antibiotic Treatment for Corynebacterium spp. Infections

Vancomycin is the first-line antibiotic treatment for Corynebacterium spp. infections, particularly for severe infections or multidrug-resistant strains. 1, 2

First-Line Treatment Options

• Vancomycin is the most consistently effective antibiotic against all Corynebacterium species, with 100% susceptibility reported across multiple studies 2, 3
• For C. jeikeium infections specifically, vancomycin is required as this species is typically multidrug-resistant 1, 2
• Linezolid shows excellent activity against Corynebacterium spp. and can be considered an alternative first-line option, particularly when oral therapy is preferred 2, 3

Alternative Treatment Options

• Teicoplanin (another glycopeptide) demonstrates excellent activity similar to vancomycin 3
• Daptomycin has shown good activity against non-diphtheria corynebacteria and can be considered for severe infections 4, 3
• Tigecycline shows promising activity against various Corynebacterium species with low MIC values (MIC₅₀ 0.064-0.125 mg/L for most species) 4
• Minocycline and doxycycline are effective against most Corynebacterium strains 2, 5

Species-Specific Considerations

• C. jeikeium and C. urealyticum are the most resistant Corynebacterium species and typically require glycopeptide therapy 2
• C. striatum infections may respond to piperacillin-tazobactam, amoxicillin-clavulanate, or cefuroxime, but vancomycin remains the treatment of choice 3
• For less severe infections caused by susceptible strains, amoxicillin-clavulanate may be appropriate 3

Combination Therapy

• For severe or invasive C. striatum infections, combination therapy with vancomycin plus piperacillin-tazobactam has been successfully used 3
• For multidrug-resistant strains, combination therapy may be considered based on susceptibility testing 6

Important Clinical Considerations

• Antimicrobial susceptibility testing is essential as resistance patterns vary significantly between species and even between strains of the same species 5
• Disk diffusion testing can be used to evaluate susceptibility to penicillin, erythromycin, clindamycin, gentamicin, and ciprofloxacin, but not for vancomycin, minocycline, or trimethoprim/sulfamethoxazole 5
• High rates of resistance have been reported to macrolides, lincosamides, fluoroquinolones, aminoglycosides, and trimethoprim/sulfamethoxazole 6, 5

Common Pitfalls and Caveats

• Do not assume predictable susceptibility patterns based solely on species identification; individual susceptibility testing is necessary 5
• Avoid empiric use of macrolides, fluoroquinolones, or trimethoprim/sulfamethoxazole due to high resistance rates 6, 5
• Despite appropriate antibiotic therapy, mortality rates of approximately 20% have been reported in invasive Corynebacterium infections, emphasizing the need for prompt and appropriate treatment 3
• Identification methods matter - gene sequencing is the gold standard for Corynebacterium identification, with MALDI-TOF and Vitek systems as acceptable alternatives 3

Treatment Algorithm

1. For severe or invasive infections: Start with vancomycin 1, 2
2. For confirmed susceptible isolates in less severe infections: Consider amoxicillin-clavulanate, piperacillin-tazobactam, or linezolid 3
3. For patients unable to tolerate vancomycin: Use linezolid, teicoplanin, or daptomycin 3
4. Always adjust therapy based on susceptibility testing results 5