Table 2.
Case Summaries
| Case No. | Organism Isolated | Mycobacterium abscessus Infection Location | Omadacycline Loading Dose | Omadacycline Maintenance Dose | Antimicrobials Before Omadacycline | Concurrent Antimicrobials | Surgical Management | Treatment Duration (Days) | Resolution | Possible Treatment-Related Adverse Events |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | M abscessus subsp bolletii | Skin (back, breast) | 450 mg daily ×2 doses | 300 mg daily | • clarithromycin, TMP-SMX • clarithromycin, linezolid • amikacin, clarithromycin, tigecycline • azithromycin, linezolid, tigecycline |
• azithromycin, linezolid • azithromycin, tedizolid |
Yes: implant removal, multiple debridements, and drainages | Total: 264 Omada: 227 |
Cure | Linezolid: cytopenias, paresthesias |
| 2 | M abscessus subps abscessus | Pulmonary | 450 mg daily ×2 doses | 300 mg daily | N/A | • amikacin, imipenem, clofazimine | Yes: wedge resection, lobectomy | Total: 227 Omada: 227 |
Cure | Amikacin: hearing loss, renal impairment Tedizolid: fatigue and dizziness |
| • clofazimine, tedizolid • clofazimine • imipenem and eravacyclinea |
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| 3 | M abscessus subsp abscessus | Skin (abdominal wall) | N/A | 300 mg daily | • azithromycin, linezolid, amikacin, imipenem | • azithromycin, amikacin • azithromycin, clofazimine |
Yes: multiple abdominal wall washouts and debridements | Total: >332 Omada: 159 |
Ongoing, but improving | Imipenem: serum sickness Amikacin: tinnitus Omadacycline: nausea and vomiting |
| 4 | M abscessus subsp abscessus | Blood, Vertebrae | N/A | 300 mg daily | • amikacin, cefoxitin, tigecycline • imipenem, tigecycline, clofazimine, bedaquiline • meropenem-vaborbactam, bedaquiline, tigecycline • meropenem-vaborbactam, bedaquiline |
• bedaquiline | Yes: epidural abscess evacuation and vertebral debridement | Total: 731 Omada: 104 |
Cure | Cefoxitin, tigecycline, bedaquiline: transaminitis Clofazimine: QTc elevation Amikacin: vestibular symptoms and mild creatinine elevation Bedaquiline: thrombocytopenia Linezolid: numbness of extremities |
Abbreviations: N/A, not applicable; NPO, nothing by mouth; TMP-SMX, trimethoprim-sulfamethoxazole.
aDuring case 2’s omadacycline course, there was a brief switch to imipenem and eravacycline when the patient was NPO for 7 days.