infectious diseases
Nocardiosis
Treatment of Nocardiosis
Trimethoprim/sulfamethoxazole (TMP/SMX) TMP/SMX 15 mg/kg/day (of the TMP component) orally every 6 to 12 hours or high doses of a sulfonamide alone (eg,sulfadiazine1 g orally every 4 to 6 hours) are used. Because most cases respond slowly, a dose that maintains a sulfonamide blood concentration of 12 to 15 mg/dL 2 hours after the last dose must be continued for a prolonged duration. The duration depends on the type of infection and predisposing risk factors of the infected patient. In immunocompromised patients and patients with disseminated disease, TMP/SMX should be used withamikacin, imipenem, ormeropenempending species identification and susceptibility testing results. When sulfonamide hypersensitivity or refractory infection is present,amikacin, atetracycline(particularlyminocycline),imipenem/cilastatin,meropenem,ceftriaxone,cefotaxime, extended-spectrum fluoroquinolones (eg,moxifloxacin), ordapsonecan be used.Tigecyclinemay be an effective alternative. In vitro susceptibility data should guide the choice of alternative antibiotics. Localized abscesses typically require incision, drainage, and surgical debridement. 