Mycobacterial infections

The antibiotic and sulfonamide ophthalmics are contraindicated in patients with a hypersensitivity to the drug or any component of the drug. These dru are also contraindicated in patients with epithelial herpes simplex keratitis, varicella, mycobacterial infection of the eye, and fungal diseases of the eye There are no significant precautions or interactions when the dru are administered as directed by the primary health care provider. 

The advent of multidrug resistant strains of Mycobacterium tuberculosis (MDR-TB) has led to increased fears of untreatable infections by serious pathogens. Rifampicin, streptomycin and, occasionally, the quinolones are drugs used in the treatment of mycobacterial infections and resistance to those agents is as described previously. There... 

Tuberculosis is on the increase in developed countries such as the USA and UK furthermore, MAI may be associated with AIDS sufferers. Hospital-acquired opportunistic mycobacteria may cause disseminated infection and also lung infections, endocarditis and pericarditis. Transmission of mycobacterial infection by endoscopy is rare, despite a marked increase in the use of flexible fibreoptic endoscopes, but bronchoscopy is probably the greatest hazard for the transmission ofM tuberculosis and other mycobacteria. Thus, biocides used for bronchoscope disinfection must be ehosen carefully to ensure that such transmission does not occur. 

Heifets LB. Drug susceptibility tests in the management of chemotherapy of tuberculosis. In Heifets LB, ed. Drug Susceptibility in the Chemotherapy of Mycobacterial Infections. Boca Raton, FL CRC Press 1991 89-122. 

Immune reconstitution syndrome A syndrome characterized by fever and worsening of clinical symptoms of opportunistic infections or new symptoms occurring within weeks after starting antiretroviral therapy. This has been described for mycobacterial infections (Mycobacterium avium complex and Mycobacterium tuberculosis), Pneumocystis proved pneumonia, toxoplasmosis,... 

Heginbotham, M. L. Magee, J. T. Pyrolysis mass spectrometry A predictor of clinical response to treatment in pulmonary oppurtunist mycobacterial infection preliminary work with M. malmoense. Zbl. Bakt. 1996, 285, 291-298. 

Lounis N, Roscigno G. (2004) In vitro and in vivo activities of rifamycin derivatives against mycobacterial infections. Curr Pharm Des 10 3229-3238. 

Mycobacterial infections - Recommended as the primary agent for the treatment of disseminated MAC. Use in combination with other antimycobacterial drugs that have shown in vitro activity against MAC. 

Hypersensitivity to any component of these products epithelial herpes simplex keratitis (dendritic keratitis) vaccinia varicella mycobacterial infections of the eye fungal diseases of the ocular structure use of steroid combinations after uncomplicated removal of a corneal foreign body. 

The aminoglycoside (see Section II.c) streptomycin was the first antimycobacterial antibiotic. It has activity against extracellular mycobacteria with a high growth rate. The macrolide antibiotics azithromycin and clarithromycin (see Section Il.d.l) were approved for the treatment of disseminated mycobacterial infections due to Mycobacterium avium complex. 

Petrini B. Non-tuberculous mycobacterial infections. Scand J Infect Dis 2006 38(4) 246-55. 

Unlabeled Uses Treatment of atypical mycobacterial infections... 

Contraindications Hypersensitivity to ciprofloxacin or other quinolones for ophthalmic administration vaccinia, varicella, epithelial herpes simplex, keratitis, mycobacterial infection, fungal disease of ocular structure, use after uncomplicated removal of a foreign body... 

Uniabeled Uses Treatment of atypical mycobacterial infections, gonorrhea, malaria, rheumatoid arthritis prevention of Lyme disease prevention or treatment of traveler s diarrhea. 

Unlabeled Uses Treatment of atypical mycobacterial infections such as Mycobacterium avium complex (MAC)... 

Unlabeled Uses Cryptosporidiosis, giardiasis, leishmaniasis, microsporidiosis, mycobacterial infections, tapeworm infestation, trichomoniasis, typhoid carriers. 

Unlabeled Uses Prophylaxis of Haemophilus influenzae type b infection treatment of atypical mycobacterial infection and serious infections caused by Staphybcoccus spe-... 

Streptomycin is mainly used as a second-line agent for treatment of tuberculosis. The dosage is 0.5-1 g/d (7.5-15 mg/kg/d for children), which is given intramuscularly or intravenously. It should be used only in combination with other agents to prevent emergence of resistance. See Chapter 47 for additional information regarding the use of streptomycin in mycobacterial infections. 

A combination of trimethoprim-sulfamethoxazole is effective treatment for a wide variety of infections including P jiroveci pneumonia, shigellosis, systemic salmonella infections, urinary tract infections, prostatitis, and some nontuberculous mycobacterial infections. It is active against most Staphylococcus aureus strains, both methicillin-susceptible and methicillin-resistant, and against respiratory tract pathogens such as the pneumococcus, Haemophilus sp, Moraxella catarrhalis, and Klebsiella pneumoniae (but not Mycoplasma pneumoniae). However, the increasing prevalence of strains of E coli (up to 30% or more) and pneumococci that are resistant to trimethoprim-sulfamethoxazole must be considered before using this combination for empirical therapy of upper urinary tract infections or pneumonia. 

Ciprofloxacin and levofloxacin are no longer recommended for the treatment of gonococcal infection in the USA as resistance is now common. However, both drugs are effective in treating chlamydial urethritis or cervicitis. Ciprofloxacin, levofloxacin, or moxifloxacin is occasionally used for treatment of tuberculosis and atypical mycobacterial infections. These agents may be suitable for eradication of meningococci from carriers or for prophylaxis of infection in neutropenic patients. 

Rifampin, usually 600 mg/d (10 mg/kg/d) orally, must be administered with isoniazid or other antituberculous drugs to patients with active tuberculosis to prevent emergence of drug-resistant mycobacteria. In some short-course therapies, 600 mg of rifampin are given twice weekly. Rifampin 600 mg daily or twice weekly for 6 months also is effective in combination with other agents in some atypical mycobacterial infections and in leprosy. Rifampin, 600 mg daily for 4 months as a single drug, is an alternative to isoniazid prophylaxis for patients with latent tuberculosis only, who are unable to take isoniazid or who have had exposure to a case of active tuberculosis caused by an isoniazid-resistant, rifampin-susceptible strain. 

Rifabutin is effective in prevention and treatment of disseminated atypical mycobacterial infection in AIDS patients with CD4 counts below 50/pL. It is also effective for preventive therapy of tuberculosis, either alone in a 3-4 month regimen or with pyrazinamide in a 2-month regimen. 

Ethambutol Inhibits mycobacterial arabinosyl transferases, which are involved in the polymerization reaction of arabinoglycan an essential component of the mycobacterial cell wall Bacteriostatic activity against susceptible mycobacteria Given as four-drug initial combination therapy for tuberculosis until drug sensitivities are known also used for atypical mycobacterial infections Oral t mixed clearance (half-life 4 h) dose must be reduced in renal failure Toxicity Retrobulbar neuritis... 

Note The treatment of mycobacterial infections has become an even more important and challenging problem because of the emergence of multiple-drug-resistant organisms and because of the acquired immunodeficiency syndrome (AIDS) pandemic, which has been associated with a marked increase in tuberculosis and infection caused by the M. avium complex. Because the microorganisms grow slowly and the diseases often are chronic, patient compliance, drug toxicity, and the development of microbial resistance present special therapeutic problems. 

Not all mycobacterial infections are caused by M. tuberculosis or M. leprae. These atypical mycobacteria require treatment with secondary medications as well as other chemotherapeutic agents. For example, M. marinum causes skin granulomas, and effective drugs in the treatment of infection are rifampin or minocycline. Mycobacterium fortuitum causes skin ulcers and the medications recommended for treatment are ethambutol, cycloserine, and rifampin in combination with amikacin. 

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