ANTIMICROBIAL MANAGEMENT OF NOCARDIA-ASTEROIDES INFECTION

Antimicrobial therapy for human nocardiosis continues to evolve, but t he first and still most commonly used therapy is sulfonamide treatment (sulfadiazine or trimethoprim/sulfamethoxazole). However, newer treat ments are needed for infections caused by resistant strains, patients intolerant to the side effects associated with sulfonamides, and patie nts who require more aggressive therapy. Patients with AIDS may fall i nto one or more of these categories. In vitro testing has shown that, at low concentrations, several antibiotic classes are inhibitory to mo st isolates of Nocardia asteroides. Imipenem, amikacin, minocycline, a nd certain third-generation cephalosporins such as cefotaxime and ceft riaxone have been successfully used to treat infection in experimental animal models and in the clinical setting. The necessary duration of long-term therapy has not yet been determined.