[Current therapy of atypical mycobacterial infections]

Abstract

Therapeutic possibilities as well as efficacy of chemotherapy in diseases caused by the 12 major species of potentially pathogenic Mycobacteria nontuberculosis are discussed. As opposed to M. tuberculosis, M. nontuberculosis share a reduced sensitivity towards a number of antibiotic and antitubercular agents, which, however, differs in terms of specificity. The resulting therapeutical problems as well as the various manifestations, which quite often present a limitation themselves, necessitate treatment indications regarding extent of disease, prognosis and course of the usually present, underlying disease. Due to the introduction of a new macrolide generation, e.g., clarithromycine, azithromycine, but also due to greater experience with quinolones, first success in treatment has been achieved in infections known to be difficult to treat (e.g., M. avium infections in AIDS patients). However, in order to avoid the development of resistant strains, and due to the frequently found synergisms in vitro, nearly all infections should be treated by means of combined chemotherapy. In infections difficult to treat, e.g., M. ulcerans, M. scrofulaceum, M. fortuitum/chelonei, surgical cleaning-up, or reduction of pathogens, is still of importance.