Early chemotherapy for non-tuberculous mycobacterial infections in patients with cystic fibrosis

Abstract

Promising results may be associated with early intervention with antimycobacterial therapy in CF patients.

Prevalence and drug resistance of mycobacteria in Turkish cystic fibrosis patients

“…This strain was found to be resistant to streptomycin, isoniazid, rifampicin, ceftazidime, clarithromycin, levofloxacin, vancomycin, imipenem, amoxicillin, ethionamide, trimethoprim-sulfamethoxazole, ofloxacin, and amoxicillin-clavulanic acid. In another study, M. abscessus , which was the causative agent of a pulmonary infection in a CF patient, was initially susceptible to clarithromycin, ethambutol, amikacin, mefoxitin and developed in vitro resistance to all these drugs except for ethambutol after therapy [ 41 ]. Jönsson et al [ 15 ] recovered a M. abscessus strain from a CF patient with persistent airway colonization, and detected that it was resistant to rifabutin, clarithromycin, clofazimine, and amikacin.…”

Nontuberculous mycobacteria

“…Because of the particular virulence demonstrated by M. abscessus , 41-45 its growing proportion among recovered NTM species has raised concern in recent years. While Mycobacterium avium complex (MAC) remains the most common species isolated (found in up to 72% of patients with NTM-positive sputum cultures 8,13,15,16,23,40,46,47 ), rates of M. abscessus have increased and in certain centers have even surpassed those of MAC. 5,17,18,24 Reported rates of M. abscessus in patients with NTM-positive sputum cultures range between 16 and 52% 16,31 Less frequently isolated species include Mycobacterium kansasii 13,23,31,46,48 and Mycobacterium fortuitum .…”

“…While Mycobacterium avium complex (MAC) remains the most common species isolated (found in up to 72% of patients with NTM-positive sputum cultures 8,13,15,16,23,40,46,47 ), rates of M. abscessus have increased and in certain centers have even surpassed those of MAC. 5,17,18,24 Reported rates of M. abscessus in patients with NTM-positive sputum cultures range between 16 and 52% 16,31 Less frequently isolated species include Mycobacterium kansasii 13,23,31,46,48 and Mycobacterium fortuitum . 7,11,12,14,15,31,40,47 The proportion of each species does vary by geography, however.…”

“…The response of CF patients to antimycobacterial therapy can be variable. While cures have certainly been reported, 15,23,46,47,57-61 so too have treatment failures. 7,26,62,63 Assessment of treatment success should include clinical evaluation, repeated sputum cultures, spirometry, and chest imaging.…”

“…78-80 Clofazimine, once developed for the treatment of Mycobacterium leprae , Mycobacterium lepromatosis , and Mycobacterium tuberculosis , 81 has also been used to achieve negative sputum cultures. 46 Its use in the United States is currently restricted by the US Food and Drug Administration but may be permitted with an investigational new drug application under an institutional review board approved protocol. Finally, aerosolized amikacin, thought to confer antimycobacterial activity without the same degree of nephrotoxicity, ototoxicity, and vestibular toxicity as intravenous amikacin, has also been shown to eradicate both MAC and M. abscessus .…”