Postoperative antibiotic therapy of cervical lymphadenitis caused by nontuberculous, atypical mycobacteria.

Background: Cervical lymphadenitis caused by atypical mycobacteria is incre asingly observed in immunocompetent children between 1 and 5 years of age. Surgical excision of all affected lymph nodes represents the treatment of c hoice. However, due to the infiltrative nature of the disease, surgery is o ccasionally unable to provide a complete cure and is associated with a high risk of recurrence. Such cases might derive benefit from an additional ant ibiotic therapy. Methods: The study includes 4 children with demonstrated o r clinically suspected nontuberculous mycobacterial lymphadenitis, in whom partial surgery had been performed. Postoperatively, two patients were trea ted with clarithromycin, rifabutin, and protionamide, the others with clari thromycin alone. Antibiotics were administered orally for 6-12 weeks and we re continued four weeks after local signs of inflammation were no longer de tectable. Results: In all cases, symptoms of lymphadenitis resolved within 1-2 months and did not recur. One patient was affected by WHO grade I leuko penia after 6 weeks, which soon disappeared after administration of rifabut in and protionamid had been discontinued. Conclusions: Postoperative antibi otic therapy seems to be an effective approach to treat residual disease fo llowing incomplete surgery. It remains to be clarified, however, if such a therapy should comprise combinations of agents or if administration of clar ithromycin alone might be sufficient.