This protocol targets patients with cutaneous Mycobacterium kansasii infection who have completed a first-line multidrug antimycobacterial course without reaching the required therapeutic endpoints — and for whom the next management step must be defined.
The first-line regimen consisted of a rifampin-susceptible multidrug antimycobacterial combination — rifampicin and ethambutol together with either isoniazid or a macrolide (clarithromycin) — maintained for a course lasting over 12 months. This line is considered to have failed when it does not achieve: complete or substantial disappearance of pre-existing skin lesions, absence of new skin lesions, and bacteriological negative conversion on mycobacterial culture. Non-achievement of these targets is the trigger for escalation to the present protocol.
When the antimicrobial regimen alone proves insufficient, management is expanded by adding a surgical intervention component to the ongoing antimicrobial treatment.
Full indications, procedural specifics, and regimen details are in the complete protocol →DOI: 10.3389/fphar.2023.1242156
For patients with extensive lesions, abscess formation and poor drug efficacy, surgical debridement or foreign body removal can be actively used.
Compared to antimicrobial agents' therapy alone, additional surgical operation of the localized infection with medication has proven to have better outcomes for extracutaneous involvement.
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