How are infections with rapidly growing mycobacteria managed?

Surgical removal can be used in patients with a limited number of lesions. Antibiotics are added in immunocompromised patients or those with numerous lesions. M. chelonae has the greatest antibiotic resistance but is usually susceptible to tobramycin, clarithromycin, and linezolid. In vitro testing has also shown the efficacy of tigeycline and amikacin. Two to four months of antibiotics is recommended in localized disease and 6 months in disseminated cutaneous disease, but the optimal length of therapy is not clear. Testing for susceptibilities is advised before treatment begins in clinically significant isolates, and if treatment fails or there is a relapse. While waiting for susceptibilities results, clarithryomycin and azithromycin are useful oral agents for M. chelonae.

Regnier S, Cambau E, Meningaud JP, et al: Clinical management of rapidly growing mycobacterial cutaneous infections in patients after mesotherapy, Clin Infect Dis 49(9):1358–1364, 2009.