What is the role of antibiotics in the treatment of mycobacterium chelonae infection?

Updated: Dec 20, 2018
  • Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Antibiotic therapy for Mycobacterium chelonae infection is generally less intense compared with Mycobacterium abscessus infections since the organism does not possess the erm gene that is responsible for inducible macrolide resistance. [6] Like many of the nontuberculous mycobacteria (NTM), the in vitro susceptibilities of M chelonae do not always correspond to the clinical response and success seen in vivo. Therefore, it is recommended that susceptibility testing be obtained to guide treatment decisions, after careful consideration of the susceptibility test limitations. [25]

Susceptibility testing for M chelonae and related mycobacteria lacks standardization and is hampered by previous studies that considered the more resistant organism, M abscessus, to be the same as M chelonae. Microbiological studies published after 2000 are more likely to be reliable than those of the 1990s, especially if published before 1992.

Most M chelonae infections are uncomplicated, localized, and may resolve before treatment is rendered. Chronic, nonresolving infection requires antimicrobial therapy guided by appropriate identification and susceptibility testing. Empiric therapy should be avoided except in unusual circumstances. One should seek consultation from experts in the field if empiric therapy is required or when difficult, life-threatening clinical scenarios arise. The authors routinely seek outside opinions when encountering unusual and difficult cases.

Macrolide antibiotics are the cornerstone of treatment for M chelonae, and either clarithromycin or azithromycin is the agent of choice. [25] Macrolide monotherapy for localized disease may be sufficient, particularly when used with surgical debridement. The development of resistance during prolonged therapy has been described with macrolide monotherapy and is less common with aminoglycoside monotherapy. [25, 29, 40]

Disseminated infection is usually treated with at least 2 drugs that include a macrolide, and a parental agent, usually an aminoglycoside. [1, 29] Treatment duration for disseminated disease is recommended to be at least 6 months or until all symptoms and signs resolve. [29, 40]

Lung disease with M chelonae is treated with at least 2 drugs that are based on in vitro susceptibility testing. Tobramycin is the preferred aminoglycoside based on in vitro minimum inhibitory concentrations (MICs). [25, 29] Treatment duration should include 12 months of negative sputum cultures. [25]


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