Current treatment for nocardia infections

Introduction: Nocardiosis is an infectious actinomycetic disease with a variable clinical spectrum that makes it difficult to diagnose. It mainly affects immunosuppressed individuals. Advances in molecular genomic technology have helped in identifying new pathogenic Nocardia species. This has made identification of their specific antimicrobial sensitivity possible. Areas covered: It is important to know the taxonomy, clinical features, diagnosis and precise species identification because of the multitude of pathogenic species involved and the different antibiotic susceptibility patterns. The authors review sulfonamides, aminoglycosides, penicillin derivatives, tetracyclines, glycylcyclines, oxazolidinones, carbapenems and the association of other potential drugs, the therapeutic effectiveness of traditional antimicrobials and new monotherapy and combined treatment alternatives. New oxazolidinones and the benzothiazinones are compounds that have been found effective in vitro and in experimental models. Expert opinion: Clinicians should be aware of nocardiosis in patients with different forms of immunosuppression. The identification of organisms, their patterns of antibiotic susceptibility and the adverse effects related to these drugs must be considered. Treatments can vary from traditional schemes with trimethoprim-sulfamethoxazole to other combination therapies and new antibiotics and treatment modalities depending on the organ or site involved, the severity of infection and the presence of comorbidities.