Safety and tolerability of a standardized treatment regimen for Mycobacterium abscessus otomastoiditis

Area of Science:

• Infectious Diseases
• Pharmacology
• Pediatric Medicine

Background:

• Mycobacterium abscessus (M. abscessus) infections require complex multidrug treatment.
• Clinical pathways aim to standardize and optimize M. abscessus treatment.
• Evaluating drug-induced adverse events is crucial for patient safety and treatment adherence.

Purpose of the Study:

• To assess the adverse events associated with a multidisciplinary clinical pathway for M. abscessus treatment.
• To identify common adverse events and reasons for treatment modification.
• To provide recommendations for managing adverse events in M. abscessus patients.

Main Methods:

• A retrospective analysis of patients treated via an institutional clinical pathway for M. abscessus.
• Documentation of adverse events, drug interruptions, and cessations.
• Evaluation of the frequency and types of adverse events observed.

Main Results:

• All ten pediatric patients experienced adverse events, frequently leading to antibiotic interruption or cessation.
• Common adverse events included gastrointestinal issues (100%), hypoalbuminemia (90%), elevated liver enzymes (70%), and hypertriglyceridemia (70%).
• Tigecycline was often implicated; however, all patients achieved clinical cure without long-term adverse effects.

Conclusions:

• Multidrug regimens for M. abscessus otomastoiditis are associated with frequent adverse events.
• Specialized team management, including clinical monitoring, laboratory tests, audiograms, and ECGs, is recommended.
• Prophylactic antiemetics are advised due to high rates of nausea and vomiting, particularly with tigecycline.