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Efficacy of imipenem therapy for Nocardia actinomycetomas refractory to sulfonamides

Mahreen Ameen1, Roberto Arenas, Elsa Vásquez del Mercado

  • 1St John's Institute of Dermatology, Guy's and St Thomas' Trust, London, United Kingdom.

Journal of the American Academy of Dermatology
|December 17, 2009
PubMed
Abstract

Insights

Sulfonamides effectively treat limited actinomycetoma (fungal infections). For severe, resistant cases, imipenem monotherapy or with amikacin shows good tolerance and efficacy, even with bone or visceral involvement.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Antimicrobial Therapy

Background:

  • Actinomycetomas are chronic subcutaneous infections caused by actinomycetes bacteria.
  • Standard antibiotic therapies can be prolonged and may fail, leading to severe complications like bone and visceral involvement.

Purpose of the Study:

  • To assess the efficacy and safety of imipenem monotherapy and imipenem-amikacin combination therapy for severe, refractory actinomycetomas.
  • To identify factors predicting treatment failure with first-line sulfonamides.

Main Methods:

  • Retrospective study of microbiologically confirmed actinomycetoma cases treated since 1995.
  • Analysis of 11 patients treated with sulfonamides and 8 patients with refractory disease treated with imipenem (alone or with amikacin).

Main Results:

  • Sulfonamides were effective in limited disease cases (mean duration 1.7 years) after 15 months of treatment.
  • Imipenem therapy (mean disease duration 10 years) in refractory cases was well-tolerated, achieving cure or significant improvement in all patients, including those with bone/visceral involvement.

Conclusions:

  • Sulfonamides are effective for early-stage actinomycetomas.
  • Imipenem, with or without amikacin, offers a well-tolerated and effective treatment option for severe, sulfonamide-resistant actinomycetomas.

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