Korean J Med.  2019 Aug;94(4):343-352. 10.3904/kjm.2019.94.4.343.

Treatment of Mycobacterium Abscessus Pulmonary Disease

Affiliations
  • 1Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea. wjkoh@skku.edu
  • 2Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Seoul, Korea.

Abstract

Mycobacterium abscessus is the second most important pathogen in pulmonary disease caused by nontuberculous mycobacteria (NTM), following Mycobacterium avium. Mycobacterium abscessus is classified into three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Mycobacterium abscessus is the most difficult to treat NTM due to its resistance to many antibiotics. Treatment should include an initial regimen of 2-3 injectable and oral antibiotics for several weeks or months, followed by inhaled amikacin and 1-3 oral antibiotics, depending on the subspecies and drug susceptibility patterns, including macrolide susceptibility. The continuation phase should be continued for a minimum of 12 months after culture conversion. Suitable injectable antibiotics include amikacin, imipenem, cefoxitin, and tigecycline, while oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and moxifloxacin. Surgery can be a useful adjunctive therapy for some patients with refractory disease. However, the overall treatment prognosis is still unsatisfactory. Therefore, novel and more effective interventions are required for the treatment of M. abscessus pulmonary disease.

Keyword

Nontuberculous mycobacteria; Mycobacterium abscessus; Treatment; Anti-bacterial agents

MeSH Terms

Amikacin
Anti-Bacterial Agents
Cefoxitin
Clofazimine
Humans
Imipenem
Linezolid
Lung Diseases*
Macrolides
Mycobacterium avium
Mycobacterium*
Nontuberculous Mycobacteria
Prognosis
Amikacin
Anti-Bacterial Agents
Cefoxitin
Clofazimine
Imipenem
Linezolid
Macrolides
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