Response to "The promise and pitfalls: interpreting dual β-lactam success in Mycobacterium abscessus with caution"

We read with interest the recent commentary (C. Mejia-Chew, ASM Case Rep 1:e00084-25, 2025, https://doi.org/10.1128/asmcr.00084-25) on our case report (M. Shimamura, B. Becken, J. Tansmore, M. Cristinziano, et al., ASM Case Rep 1:e00087-24, 2025, https://doi.org/10.1128/asmcr.00087-24). β-lactam therapy represents a mechanistically rational and clinically promising strategy for Mycobacterium abscessus, a pathogen with limited therapeutic options. Reported cases of β-lactam combinations illustrate how in vitro data, translational insights, and multidisciplinary clinical decision-making can inform salvage therapy in the absence of robust animal preclinical or clinical trial data. While challenges remain-including lack of standardized synergy testing, limited animal models, and complex polytherapy-these experiences underscore the importance of transparent reporting and provide the platform for rigorously evaluating β-lactam regimens.