cefoxitin and Tuberculosis--Pulmonary

To screen effective useful drugs for disease due to M. abscessus, we determined MIC of 3 cephems [ceftazidime (CAZ), cefoxitin (CFX), flomoxef (FMOX)] and 3 carbapenems [imipenem (IPM), panipenem (PAPM), meropenem (MEPM)] for 8 strains of clinically isolated M. abscessus by micro-dilution method using MGIT system. In all the 8 strains, MICs of CAZ are higher than 32 micrograms/ml. MIC50, MIC90, MIC range of CFX are 32 micrograms/ml, > 32 micrograms/ml and 16- > 32 micrograms/ml respectively, and for FMOX, 16 micrograms/ml, 32 micrograms/ml and 16-32 micrograms/ml; for IPM, 8 micrograms/ml, 16 micrograms/ml and 8-16 micrograms/ml; for PAPM, 4 micrograms/ml, 16 micrograms/ml and 4-16 micrograms/ml; for MEPM, 8 micrograms/ml, 16 micrograms/ml and 8-16 micrograms/ml. From this study, it is concluded that FMOX, IPM, PAPM and MEPM can be clinically useful drugs in the treatment of the disease due to M. abscessus.

Topics: Carbapenems; Cefoxitin; Ceftazidime; Cephalosporins; Drug Resistance, Bacterial; Humans; Imipenem; Meropenem; Microbial Sensitivity Tests; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous; Thienamycins; Tuberculosis, Pulmonary

We present a case of pulmonary infection with Mycobacterium fortuitum demonstrating the development of multidrug resistance during therapy with multiple drugs. Emergence of drug resistance in a previously sensitive M fortuitum has been described with single drug therapy, but never before with multiple drug treatment. Development of resistance in the setting of multiple drug therapy illustrates the importance of repeated susceptibility testing during therapy.

Topics: Carcinoma, Squamous Cell; Cefoxitin; Drug Resistance, Microbial; Drug Therapy, Combination; Erythromycin; Humans; Lung Neoplasms; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Tuberculosis, Pulmonary