This protocol covers first-line management of cutaneous nocardiosis presenting as mild, nondisseminated disease — a clinically distinct situation where infection remains confined to the skin and systemic spread has not occurred.
Nondisseminated cutaneous nocardiosis most commonly arises from direct inoculation — through trauma or environmental skin disruption such as contact with a thorn — rather than systemic spread. Patients are often immunocompetent without an apparent predisposing condition. Mild nocardiosis in this setting is typically managed in the outpatient setting and follows a chronic course before diagnosis, with infection remaining nondisseminated.
For mild, nondisseminated cutaneous nocardiosis, management centres on single-agent antibiotic monotherapy, with trimethoprim-sulfamethoxazole (TMP-SMX) as the most well-studied and preferred first-line agent. The full protocol — including dosing, duration, monitoring, and susceptibility-guided refinements — is available via the link below.
Treatment goal: signs of clinical improvement of the cutaneous infection.
Nondisseminated cutaneous nocardiosis is commonly the result of direct inoculation, either through trauma or environmental skin disruption (eg, contact with a thorn).
Patients with nondisseminated cutaneous nocardiosis are commonly immunocompetent without apparent predisposing condition.
Although no validated grading system for Nocardia severity exists, patients with mild nocardiosis are often managed in the outpatient setting, have a chronic course leading to diagnosis, and have nondisseminated infection.
Those with mild infection can start with a single antibiotic that is highly likely to be an active agent.
TMP-SMX is the most well-studied and preferred agent for monotherapy.