Mycobacterium marinum: Current Recommended Pharmacologic Therapy

Twenty-eight cases of Mycobacterium marinum infection: retrospective case series and literature review

“…Other case series have reported mean treatment durations ranging from 2.7 to 8.3 months, with shorter durations reported among case series of cutaneous M. marinum infection [1, 5, 11–21]. In our study, ethambutol was the most frequently used antibiotic, followed by rifampin, clarithromycin, and azithromycin in accordance with ATS/IDSA guidelines [2, 6]. The high rate of multidrug therapy and longer duration of treatment in our study probably reflect the higher rate of invasive infections among our cohort.…”

“…The most recent treatment recommendations from the 2007 joint American Thoracic Society (ATS) and Infectious Disease Society of America (IDSA) guidelines recommend 2 active agents (clarithromycin/azithromycin, ethambutol, or rifampin) for 3–4 months with adjunctive surgical debridement for invasive infections [2, 6]. However, a recent Chinese study demonstrated that monotherapy with clarithromycin can be an effective regimen for simple cutaneous infection, and some case series of cutaneous infection have demonstrated high treatment success rates with single-drug treatment [8, 13, 15].…”

“…Infection results in ulcerating or nodular skin lesions that can progress to more invasive disease, including tenosynovitis, septic arthritis, or osteomyelitis, particularly if there is a delayed diagnosis or the patient is immunocompromised [2, 5]. Treatment usually involves a prolonged course of antimicrobial therapy with 2 active agents; however up to half of all cases may require surgery when persistent or deeper infection is present [2, 5, 6]. …”

“…While cases are rare, with an estimated annual incidence of 0.27 cases per 100,000 persons in the United States, out-breaks have been recently reported among patrons of sea-food markets in New York City and at a fish farm in China [6–8]. …”

Detection of Mycobacterium marinum in clinically asymptomatic Siamese fighting fish (Betta splendens) from ornamental fish shops in Chiang Mai Province, Thailand

“…Osteomyelitis and tenosynovitis can be observed in some cases [4]. The recommended chemotherapeutic regimens for M. marinum infection in humans include rifampicin plus ethambutol, clarithromycin, rifampicin, ethambutol and amikacin, or trimethoprim/sulfamethoxazole, with variable susceptibility to minocycline, doxycycline, and streptomycin [5,6].…”