2006, Number 3
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ABSTRACTIntroduction: Dapsone with trimethoprim-sulfamethoxazol is currently the standard treatment for actinomycetoma. In select cases, amikacin, streptomycin, kanamycin, amoxicillin/clavulanic acid or phosphomycin may be also added. Imipenem has shown to be effective both in vitro and in vivo against some actinomycetes. Amikacin with Imipenem has a synergistic effect.
Objectives: To report our preliminary findings using imipenem alone or with amikacin for severe or multi-resistant mycetomas due to Nocardia sp.
Material and Methods: We present 5 cases of chronic mycetoma infection previously treated with anti-bacterial multidrug regimens. All patients were hospitalized and treated with imipenem 500 mg IV, three times a day for three weeks. Three patients received in addition amikacin.
Results: We included 3 male and 2 female patients. The average length of disease duration was 7.4 years. In 3 cases mycetoma was located on the back; one of them involved the rib and the lung. One case was localized in the abdominal wall, and another one involved the posterior side of the cervical region. Two patients achieved clinical and bacteriological cure one year after treatment with Imipenem, and the remaining three displayed clinical improvement, even though grains were observed, cultures where negative. None of the 5 patients studied showed clinical evidence of adverse reactions to Imipenem.
Conclusions: Imipenem is a strong antibiotic and constitutes an important treatment alternative for severe or multi-resistant mycetoma especially for cases with bone and visceral involvement.
Arenas R. Micología Médica Ilustrada. Interamericana-McGraw-Hill. 2ª. Edición, México. 2003:113-117.
Gómez A, Saúl A, Bonifaz A. Amoxicilin and clavulanic acid in the treatment of actinomicetoma. Int J Dermatol 1993;32:218-220.
Welsh O, Sauceda E, Gonzalez J. Amikacin alone and in combination with trimethoprim-sulfamethoxazole in the treatment of actinomycotic mycetoma. J Am Acad Dermatol 17:443-448.
Welsh O. Treatment of actinomycetoma. Arch Med Res 1993;24:413-415.
Yoneyama T, Yamakani I, Mine S. Nocardial brain abscess: surgery and postoperative antibiotic therapy. No Shinkei Gek. 2004;32:457-462.
Ogg G, Lynn WA, Peters M. Cerebral Nocardia abscesses in a patient with AIDS: correlation of magnetic resonance and white cell scanning images with neuropathological findings. J Infect 1997;35:311-313.
Hui CH, Au VW, Rowland K. Pulmonary nocardiosis revisited: experience of 35 patients at diagnosis. Respir Med 2003;97:709-717.
Narushima M, Susuki H, Kasai T. Pulmonary nocardiosis in a patient treated with corticosteroid therapy. Respirology 2002;7:87-89.
Folgaresi M, Ferdani G, Coppini M. Primary cutaneous nocardiosis. Eur J Dermatol 1998;8:430-431
Baril L, Boiron P, Manceron V. Refractory craniofacial actinomycetoma due to Streptomyces somaliensis that required salvage therapy with amikacin and Imipenem. Clin Infect Dis 1999;29:460-461.
Méndez-Tovar L, Serrano-Jean L, Almeida-Arvizu VN, et al. Cefotaxima más amikacina asociadas a inmunomodulación en el tratamiento de Actinomicetoma resistente a tratamiento convencional. Gac Med Mex 1999;135:517-521.
Wortman PD. Treatment of a Nocardia brasiliensis mycetoma with sulfamethoxazole and trimethoprim, amikacin, and amoxicillin and clavulanate. Arch Dermatol 1993;129:564-567.
Fernández RF, Arenas R, Reyes M, Zacarías R. Micetoma dorsal por Nocardia brasiliensis. Comunicación de un caso curado con Imipenem y amikacina. Dermatología Rev Mex 2005; 49:178-181.
Dubreuil L, Devos J, Romond C. In vitro activity of Imipenem against grampositive anaerobic bacteria. Int J Clin Pharmacol Res 1987;7:39-43.
Calandra GB, Ricci FM, Wong C, et al. Safety and tolerance comparison of Imipenem-cilastatin to cephalotin and cefazolin. J Antimicron Chemother 1983;12 (Suppl D):125-131.
Sadon A, Gilden BN, Rohr AS, et al. Immediate hypersensitivity reactions to betalactam antibiotics. Ann Intern Med 1987;127:204-215.
Gombert ME, Aulicino TM, Dubouchet L, et al. Therapy of experimental cerebral nocardiosis with imipenem, amikacin, trimethoprim-sulfamethoxazole, and minocyline. Antimicrob Agents Chemother 1986;30:270-273.
Kanemitsu K, Kunishima K, Saga T. Efficacy of amikacin combinations for nocardiosis. Tohoku J. Exp. Med 2003;201:157-163.
Gomez-Flores A, Welsh O, Said-Fernandez S, et al. In vitro and in vivo activities of antimicrobials against Nocardia brasiliensis. Antimicrob Agents Chemother 2004;48:832-837.
Moylett EH, Pacheco SE, Brown-Elliott BA, et al. Clinical experience with Linezolid for the treatment of Nocardia infection. Clin Infect Dis 2003; 36:313.