. 2020 Sep;152(3):185–226. doi: 10.4103/ijmr.IJMR_902_20

Table XV.

Suggested antibiotic regimens for adults with Mycobacterium abscessus-pulmonary disease

M. abscessus	Antibiotic regimen
Clarithromycin sensitive isolates	Initial phase: ≥1 month^† Intravenous amikacin 15 mg/kg daily or 3×per week^‡ and intravenous tigecycline 50 mg twice daily and where tolerated intravenous imipenem 1 g twice daily and where tolerated oral clarithromycin 500 mg twice daily or oral azithromycin 250-500 mg daily. Continuation phase: Nebulized amikacin^‡ and oral clarithromycin 500 mg twice daily or azithromycin 250-500 mg daily and 1-3 of the following antibiotics guided by drug susceptibility results and patient tolerance: Oral clofazimine 50-100 mg daily^¦ Oral linezolid 600 mg daily or twice daily Oral moxifloxacin 400 mg daily
Inducible macrolide-resistant isolates or constitutive macrolide-resistant isolates	Initial phase: ≥1 month^† Intravenous amikacin 15 mg/kg daily or 3× per week^‡ and intravenous tigecycline 50 mg twice daily and where tolerated intravenous imipenem 1 g twice daily. Continuation phase: Nebulized amikacin^‡ and 2-3 of the following antibiotics guided by drug susceptibility results and patient’s tolerance: Oral clofazimine 50-100 mg daily^¦ Oral linezolid 600 mg daily or twice daily Oral moxifloxacin 400 mg daily

M. abscessus

Antibiotic regimen

Clarithromycin sensitive isolates

Initial phase: ≥1 month^† Intravenous amikacin 15 mg/kg daily or 3×per week^‡ and intravenous tigecycline 50 mg twice daily and where tolerated intravenous imipenem 1 g twice daily and where tolerated oral clarithromycin 500 mg twice daily or oral azithromycin 250-500 mg daily.
Continuation phase: Nebulized amikacin^‡ and oral clarithromycin 500 mg twice daily or azithromycin 250-500 mg daily and 1-3 of the following antibiotics guided by drug susceptibility results and patient tolerance:
Oral clofazimine 50-100 mg daily^¦
Oral linezolid 600 mg daily or twice daily
Oral moxifloxacin 400 mg daily

Inducible macrolide-resistant isolates or constitutive macrolide-resistant isolates

Initial phase: ≥1 month^†
Intravenous amikacin 15 mg/kg daily or 3× per week^‡ and intravenous tigecycline 50 mg twice daily and where tolerated intravenous imipenem 1 g twice daily.
Continuation phase: Nebulized amikacin^‡ and 2-3 of the following antibiotics guided by drug susceptibility results and patient’s tolerance:
Oral clofazimine 50-100 mg daily^¦
Oral linezolid 600 mg daily or twice daily
Oral moxifloxacin 400 mg daily

^†Due to the poor response rates in patients with inducible or constitutive macrolide-resistant isolates and the greater efficacy of antibiotics administered through the intravenous route, extending the duration of intravenous antibiotic therapy to 3-6 months in those who can tolerate it may be the most appropriate treatment strategy in this subgroup of patients. ^‡Substitute intravenous/nebulized amikacin with an alternative antibiotic if the M. abscessus is resistant to amikacin (i.e., MIC >64 mg/l or known to have a 16S rRNA gene mutation conferring constitutive amikacin resistance). ^§Start clofazimine during the initial phase of treatment if tolerated as steady-state serum concentrations may not be reached until ≥30 days of treatment. Lower dose of intravenous tigecycline (25-50 mg once daily) may be given if not tolerated. Source: Adapted with permission from Ref. 1