# Response to “The promise and pitfalls: interpreting dual β-lactam success in Mycobacterium abscessus with caution”

## TL;DR

This paper responds to a commentary on a case report about using β-lactam antibiotics for treating Mycobacterium abscessus, highlighting the potential and challenges of this approach.

## Contribution

The paper emphasizes the value of case reports in guiding β-lactam therapy for M. abscessus despite limited clinical trial data.

## Key findings

- β-lactam combinations show clinical promise for M. abscessus when guided by in vitro and translational insights.
- Challenges include lack of standardized synergy testing and limited animal models for evaluating β-lactam regimens.
- Transparent reporting of cases is critical for advancing the evaluation of β-lactam therapies.

## Abstract

We read with interest the recent commentary (C. Mejia-Chew, ASM Case Rep 1:e00084-25, 2025, https://doi.org/10.1128/asmcr.00084-25) on our case report (M. Shimamura, B. Becken, J. Tansmore, M. Cristinziano, et al., ASM Case Rep 1:e00087-24, 2025, https://doi.org/10.1128/asmcr.00087-24). β-lactam therapy represents a mechanistically rational and clinically promising strategy for Mycobacterium abscessus, a pathogen with limited therapeutic options. Reported cases of β-lactam combinations illustrate how in vitro data, translational insights, and multidisciplinary clinical decision-making can inform salvage therapy in the absence of robust animal preclinical or clinical trial data. While challenges remain—including lack of standardized synergy testing, limited animal models, and complex polytherapy—these experiences underscore the importance of transparent reporting and provide the platform for rigorously evaluating β-lactam regimens.