Moderate disease

For initial empirical therapy of nocardiosis in patients with moderate disease (see Nocardiosis disease categories for treatment), use:

trimethoprim+sulfamethoxazole (adult more than 60 kg: 320+1600 mg; adult 40 to 60 kg: 240+1200 mg; child 1 month or older: 6+30 mg/kg up to 240+1200 mg) orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment nocardiosis, moderate trimethoprim + sulfamethoxazole    

PLUS EITHER

1 ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, daily nocardiosis ceftriaxone    

OR

1 linezolid 600 mg orally, 12-hourly (child younger than 12 years: 10 mg/kg up to 600 mg orally, 8-hourly). For dosage adjustment in adults with kidney impairment, see linezolid dosage adjustment. nocardiosis, moderate linezolid    

Modify therapy based on the results of species identification and susceptibility tests, if possible. When susceptibility is known, continue therapy with two antimicrobials to which the organism is susceptible to complete a duration of at least 2 weeks, or longer if there is a slow response. Unless the isolate is resistant, drug desensitisation is recommended for patients who are hypersensitive to trimethoprim+sulfamethoxazole—seek expert advice.

Follow initial two-drug therapy with oral eradication therapy using a single drug, to complete a total duration (initial + eradication therapy) of 3 to 12 months, depending on clinical response. If susceptible, use:

trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly for up to 12 months’ total duration (initial + eradication therapy). trimethoprim + sulfamethoxazole     For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment.

If there is resistance to trimethoprim+sulfamethoxazole, or if the patient is hypersensitive to trimethoprim+sulfamethoxazole and desensitisation cannot be performed, alternative options for oral eradication therapy include amoxicillin+clavulanate, minocycline, linezolid or moxifloxacin, depending on susceptibility—seek expert advice.