Medical Care
Collect more data to establish the presence of disease. Clinical response to specific antimycobacterial therapy indicates possible disease presence. As with other mycobacterial organisms, slow resolution of radiographic infiltrates is expected.
The most effective treatment regimen has not been established, but in vitro susceptibilities suggest clarithromycin and, possibly, azithromycin, quinolones (especially levofloxacin), and ethambutol as treatment options. Rifabutin may be beneficial, and rifampin shows variable results.
The recommended duration of therapy is not established, although treating patients until culture results are documented as negative is reasonable.
Whether additional or extended (as with tuberculosis) treatment prevents relapse remains unknown.
Consultations
See the list below:
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Infectious disease specialist
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Pulmonologist
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Hematologist (if bone marrow is involved)
Further Outpatient Care
Treat in an outpatient setting. Evaluate the patient monthly for adverse effects.
Further Inpatient Care
M gordonae infections should be treated until symptoms resolve. Prolonging treatment may prevent relapse, but the optimal treatment duration is unknown. Three, 6, and 12 months of therapy have been used. The improvement of objective abnormalities (eg, chest radiograph findings) may also be useful in determining the optimal duration of treatment. If the treatment time is too short, relapse may occur. If the treatment time is too long, the adverse effects of medication may become a concern.
Isolation is not indicated (once active tuberculosis infection is excluded); however, the presence of acid-fast organisms on a stain should prompt immediate isolation unless the patient is clearly not acutely contagious.
Inpatient & Outpatient Medications
At least 2 daily drugs are indicated for documented M gordonae disease. Intermittent therapy has not been evaluated.
Transfer
Transfer to other facilities is unnecessary. Consultation with an expert from the National Jewish Medical and Research Center in Denver, Colo; Centers for Disease Control and Prevention in Atlanta, Ga; local infectious disease experts; or the department of health may be useful.
