Mycobacterium marinum Infection Treatment & Management

Updated: Jan 25, 2023
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Medical Care

The mainstay of treatment in M marinum infection is antimicrobial therapy.

In the absence of clinical trial data, current treatment guidelines recommend treatment with 2 antibiotics until 2 months after resolution of symptoms. The treatment duration typically is 3-4 months, longer if deeper structures are involved.{ref 51} The 2007 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) statement recommends treatment with 2 active drugs until 1–2 months with ethambutol and macrolide combinations due to better efficacy and tolerability, and monotherapy can be considered with minimal disease. [11]  

The most commonly used antibiotic is clarithromycin according to several studies, and other alternatives include trimethoprim/sulfamethoxazole, linezolid, and tetracyclines. Routine susceptibility testing may be considered for isolates due to the potential for resistance to tetracyclines and fluroquinolones. [6]

 

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Surgical Care

Surgical drainage of skin lesions may be unnecessary. Complicated infections with involvement of deeper structures may require surgery.

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Consultations

An infectious disease specialist can establish the diagnosis and suggest management. A dermatologist also can provide expertise.

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Prevention

People who work near salt water should take precautions to avoid abrasions, trauma, or bites from fish and marine animals.

People who work in aquariums should wear gloves if they are cleaning tanks or expect to encounter trauma to their hands or feet.

If abrasions or bites occur, cleanse the skin with an antibacterial preparation and dress with an appropriate bandage.

Recommended concentrations of free chlorine in swimming pool water should be kept between 0.4 and 1 mg/L. [12]

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Long-Term Monitoring

Patients with M marinum infection are treated in an outpatient setting.

Follow-up visits with patients should be scheduled weekly until they begin to respond to therapy and then biweekly until the infection is fully cured.

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Inpatient & Outpatient Medications

Continue combination therapy or monotherapy 1-2 months after the infection resolves.

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Transfer

Transfer to other facilities is unnecessary.

Refer patients with M marinum infection to an infectious diseases physician or a dermatologist in an outpatient clinical setting.

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