Treatment of Mycobacterium abscessus Complex

Abstract

Of the nontuberculous mycobacteria (NTMs) causing lung disease, members of the complex (MABc) present a formidable obstacle to successful management. This challenge starts from a poorly understood pathogenesis, continues with complicated subspecies variation in treatment response, and extends to the multidrug-resistant nature of these organisms. The disease often necessitates the use of intravenous therapy, toxic drug combinations, and, in some cases, lung resection. Like many NTMs, MABc treatment requires prolonged therapy with multiple medications, and pulmonary disease in some subspecies can be impossible to eradicate or cure. This disease also represents a frequent and unique problem in certain populations, including cystic fibrosis and lung transplant recipients, and providers who manage such patients should be familiar with how MABc disease influences management. Because of the rising prevalence of the MABc, especially in patients with complicated underlying pulmonary disease, it is increasingly necessary for infectious diseases and pulmonary medicine clinicians to understand the unique aspects of MABc management and understand when to obtain expert consultation in the care of these patients.

Mechanism and resistance for antimycobacterial activity of a fluoroquinophenoxazine compound

“…In M . abscessus , MmpL has been associated with drug resistance through efflux pumps [45]. Additionally, mutations on MmpL11 proteins has been associated with impairment of biofilm formation in M .…”

Top Questions in the Diagnosis and Treatment of Pulmonary M. abscessus Disease

“…To mitigate the development of drug resistance, clinicians caring for CF patients colonized with M. abscessus should try to avoid the use of antibiotics such as macrolides, aminoglycosides, imipenem, and linezolid to treat other infections that may occur in this population [12]. M. abscessus pulmonary disease in patients with CF is considered to be a contraindication to lung transplantation by some centers, although there are increasing data demonstrating good outcomes in this patient population when an aggressive management and surveillance strategy is used [7, 24].…”

“…An induction phase usually includes 1 or more intravenous agents for at least 8 weeks depending on tolerability. Subsequently, a consolidation phase with oral or inhaled agents is usually undertaken for 12–18 months, with consideration for the suppressive phase in patients at high risk of relapse [7]. However, the ultimate regimen and duration depend on the extent of drug resistance and tolerability of therapy.…”

“…Many questions remain regarding the optimal timing for surgery, including duration of pre- and postoperative antibiotic therapy, which would be better informed by well-designed clinical trials. Experts recommend antimycobacterial pretreatment before resection to potentially decrease bacillary burden, with the goal of reducing postoperative complications including bronchopleural fistula formation, followed by a prolonged postoperative treatment course [7, 26].…”

Inhaled Antibiotics for Mycobacterial Lung Disease

“…There are general therapeutic principles that are uniformly followed across all pathogenic NTM species, such as the use of three to four antibiotics, and that therapy should continue for at least 12 months following sputum conversion [3]. After these basic principles, treatment regimens vary depending on species, clinical phenotype, and drug susceptibility profiles [26,27,28], leading to favorable treatment outcomes ranging between 8–88% [29,30,31,32,33]. The variability in successful treatments are often predicated upon the causative agents (i.e., M. avium versus M. abscessus ), bacterial subspecies (i.e., M. abscessus subsp.…”