Nocardia infection, treatment

Nocardia infections have been treated successjully, but failures also have been reported. Although a combination of doxycycline and streptomycin or gentamicin is considered the treatment of choice for brucellosis, trimethoprim—sulfamethoxazole may be an effective substitute for the doxy-cyctine combination. Trimethoprim—sulfamethoxazole also has been used successjully for Whipple s disease, Stenotrophomonas maltophilia infection, and infection by the intestinal parasites Cyclospora and Isospora. 

Trisulfapyrimidine (a combination of sulfadiazine, sulfamerazine, and sulfamethazine), trimethoprim-sulfamethoxazole, or sulfisoxazole can be used as an alternative drug for the treatment of melioidosis caused by Pseudomonas pseudomallei and for infections produced by Nocardia spp. 

Trimethoprim is fairly active against a variety of Grampositive cocci and Gram-negative rods. Established indications for co-trimoxazole are infections of the sinuses, ears, lungs, and urinary tract, and infections due to Salmonella, Nocardia, Brucella, Stenotrophomonas maltophilia, Pneumocystis proved, and Toxoplasma (1,6). Co-trimoxazole is also used in the treatment of Wegener s granulomatosis, for prevention of spontaneous bacterial peritonitis, and in patients with advanced HIV infection for the prophylaxis of opportunistic infections (1,6). 

A 66-year-old man with pulmonary fibrosis and cor pulmonale was given intravenous co-trimoxazole for 3 weeks followed by oral treatment for an infection with Nocardia farcinica. On day 3 of oral treatment, he... 

Resistance to sulfonamides is now common for N. meningitidiSy as well as in cases of bacillary dysentery. Antibiotics have generally replaced the sulfonamides for these purposes. Sulfonamides, particulady sulfisoxazole and sulfadiazine, are of value in treatment of infections due to Nocardia species, and sulfonamides are effective for trachoma. Inclusion conjunctivitis is also treated with sulfacetamide ointment. Oral administration of a sulfonamide, eg, sulfisoxazole, has been successful for treatment of lymphogranuloma venereum and chancroid Dapsone and sulfonamides have also been used for treatment of the skin disorder dermatitis herpetiformis. Sulfonamides have been used for long term prophylaxis of rheumatic fever, but are being replaced by penicillin for this purpose, except in cases of hypersensitivity to penicillin (19). 

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