Successful Systemic and Topical Treatment of Mycobacterium abscessus Otomastoiditis

Antimicrob Agents Chemother. 2019 Dec 20;64(1):e01203-19. doi: 10.1128/AAC.01203-19. Print 2019 Dec 20.

Abstract

Mycobacterium abscessus is an extensively drug-resistant opportunistic pathogen that can cause chronic otomastoiditis. There are no evidence-based treatment regimens for this severe infection. We treated four children with M. abscessus otomastoiditis with a structured regimen of topical imipenem and tigecycline, intravenous imipenem and tigecycline, and oral clofazimine and azithromycin and adjunctive surgery. This structured approach led to cure, with 1 year of follow-up after treatment. Adverse events were frequent, mostly caused by tigecycline.

Keywords: Mycobacterium; Mycobacterium abscessus; clofazimine; experimental therapeutics; mastoiditis; otitis; otitis media; pediatric drug therapy; tigecycline.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Adolescent
  • Anti-Bacterial Agents / administration & dosage*
  • Azithromycin / administration & dosage
  • Child
  • Clofazimine / administration & dosage
  • Combined Modality Therapy
  • Drug Therapy, Combination / adverse effects
  • Female
  • Humans
  • Imipenem / administration & dosage
  • Injections, Intravenous
  • Instillation, Drug
  • Male
  • Mastoidectomy
  • Mastoiditis / diagnostic imaging
  • Mastoiditis / drug therapy*
  • Mastoiditis / microbiology
  • Mycobacterium Infections, Nontuberculous / diagnostic imaging
  • Mycobacterium Infections, Nontuberculous / drug therapy*
  • Mycobacterium Infections, Nontuberculous / microbiology
  • Mycobacterium abscessus* / drug effects
  • Mycobacterium abscessus* / isolation & purification
  • Proton-Translocating ATPases
  • Tigecycline / administration & dosage
  • Tigecycline / adverse effects
  • Tympanoplasty

Substances

  • Anti-Bacterial Agents
  • Tigecycline
  • Imipenem
  • Azithromycin
  • Clofazimine
  • Proton-Translocating ATPases