Introduction
There is currently a limited role for antimicrobials in the management of infection and disease caused by Mycobacterium avium subsp. paratuberculosis (MAP). Yet, one can envision several potential roles, spanning from treatment of infected animals to prevention of onward spread to management of infection in spillover hosts, including humans.
In order to select antimicrobial agents, whether existent or novel, a first step is determining which agents can inhibit the growth of MAP in vitro. This is based on the premise that, while an agent that is active in vitro may or may not be active in vivo, an agent that does not manifest activity in vitro is unlikely to achieve activity in vivo. As a foundation for such studies, it is critical to have a robust laboratory approach to assess activity. This test is often called an antimicrobial susceptibility test (AST), also known in the mycobacteria field as drug susceptibility testing (DST) (see Box 10.1).This chapter will emphasize DST in the context of mycobacteria while focusing on the slow- growing organism MAP. First, a general overview of DST on mycobacteria and how DST is carried out in clinical microbiology labs will be provided. Second, reasons for establishing standardized DST in MAP will be discussed. Finally, new methods and current progress on antimicrobial treatment of MAP will be highlighted.
10.2
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