Tetracycline derivatives, alternative treatment for nocardiosis in transplanted patients

Nocardiosis is a rare infection in patients with immunosuppression following transplantation. Thus far, treatment with sulfa derivatives, when combined with immunosuppressive agents, has been shown to carry an unacceptably high rate of toxic effects. Therefore, the possibility of using an alternative antimicrobial treatment was investigated. The treatment of disseminated Nocardia infection with doxycycline or minocycline in patients after either kidney, bone marrow or liver transplantation was investigated retrospectively. Three patients were treated at The Hadassah University Hospital in Jerusalem. Antibiotic treatment with tetracyclines was administered for one to 14 months at a dose of 100 to 600 mg/d. Additional seven patients were reviewed from previous published reports. Nine out of the ten treated patients had an uneventful recovery. One non-compliant patient died of disseminated nocardiosis. In conclusion, the favorable outcome of the patients treated with minocycline for Nocardia infection which developed after transplantation, suggests that this antibacterial agentis is both effective and safe. These data support the recommendation that tetracycline derivatives may be considered as an alternative treatment for Nocardia infections in transplanted patients.