Efficacy of Clarithromycin and Ethambutol for <i>Mycobacterium avium</i> Complex Pulmonary Disease. A Preliminary Study

Miwa, Seiichi; Shirai, Masahiro; Toyoshima, Mikio; Shirai, Toshihiro; Yasuda, Kazumasa; Yokomura, Koshi; Yamada, Takashi; Masuda, Masafumi; Inui, Naoki; Chida, Kingo; Suda, Takafumi; Hayakawa, Hiroshi

doi:10.1513/annalsats.201308-266oc

Cited by 106 publications

(65 citation statements)

References 18 publications

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“…In addition, one patient developed macrolide-resistant MAC-LD after antibiotic treatment for M. massiliense lung disease. Previous studies from Japan and the United States showed that macrolide resistance did not develop even in patients with persistent positive sputum cultures after more than 12 months of recommended multidrug antibiotic treatment (48,49). Our previous study found that 17% of patients with an unfavorable microbiologic response after 12 months of multidrug antibiotic therapy developed macrolide resistance (19).…”

Section: Discussionmentioning

confidence: 82%

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

Moon

Park

Kim

et al. 2016

Antimicrob Agents Chemother

103

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Section: Discussionmentioning

confidence: 82%

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

Moon

Park

Kim

et al. 2016

Antimicrob Agents Chemother

103

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“…Another possible means to increase the AZM C max is to use a two-drug regimen (AZM and EMB) without RIF or with the substitution of other drugs, such as clofazimine, for RIF. A preliminary randomized study showed that the clinical efficacy of a daily two-drug regimen (CLR and EMB) was similar to that of a daily three-drug regimen (CLR, EMB, and RIF) for MAC-LD (39). In addition, the replacement of RIF with clofazimine and daily treatment with CLR or AZM, EMB, and clofazimine achieved similar treatment outcomes in patients with MAC-LD in two retrospective studies (40,41).…”

Section: Discussionmentioning

confidence: 94%

Peak Plasma Concentration of Azithromycin and Treatment Responses in Mycobacterium avium Complex Lung Disease

Jeong

Jeon

Park

et al. 2016

Antimicrob Agents Chemother

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d Macrolides, such as azithromycin (AZM) and clarithromycin, are the cornerstones of treatment for Mycobacterium avium complex lung disease (MAC-LD). Current guidelines recommend daily therapy with AZM for cavitary MAC-LD and intermittent therapy for noncavitary MAC-LD, but the effectiveness of these regimens has not been thoroughly investigated. This study evaluated associations between microbiological response and estimated peak plasma concentrations (C max ) of AZM. The AZM C max was measured in patients receiving daily therapy (250 mg of AZM daily, n ‫؍‬ 77) or intermittent therapy (500 mg of AZM three times weekly, n ‫؍‬ 89) for MAC-LD and daily therapy for Mycobacterium abscessus complex LD (MABC-LD) (250 mg of AZM daily, n ‫؍‬ 55). The AZM C max was lower with the daily regimen for MAC-LD (median, 0.24 g/ml) than with the intermittent regimen for MAC-LD (median, 0.65 g/ml; P < 0.001) or daily therapy for MABC-LD (median, 0.53 g/ml; P < 0.001). After adjusting for confounding factors, AZM C max was independently associated with favorable microbiological responses in MAC-LD patients receiving a daily regimen (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 1.01 to 2.48; P ‫؍‬ 0.044) but not an intermittent regimen (aOR, 0.85; 95% CI, 0.58 to 1.23, P ‫؍‬ 0.379). With the daily AZM-based multidrug regimen for MAC-LD, a low AZM C max was common, whereas a higher AZM C max was associated with favorable microbiologic responses. The results also suggested that the addition of rifampin may lower AZM C max . When a daily AZM-based multidrug regimen is used for treating severe MAC-LD, such as cavitary disease, the currently recommended AZM dose might be suboptimal. (This study has been registered at ClinicalTrials.gov under identifier NCT00970801.)

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“…The scientific evidence base for most recommendations is narrow and is largely derived from retrospective cohort studies, drug susceptibility surveys, or animal experiments [100,101,102]. Only one prospective, placebo-controlled clinical trial on pulmonary infections caused by MAC is available, which compares the treatment outcome of pulmonary MAC infection with and without additional aminoglycoside in addition to the standard treatment regimen [103].…”

Section: Managementmentioning

confidence: 99%

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

Wassilew¹,

Hoffmann²,

Andréjak³

et al. 2016

Respiration

127

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Non-tuberculous mycobacteria (NTM) include more than 160 ubiquitous, environmental, acid-fast-staining bacterial species, some of which may cause disease in humans. Chronic pulmonary infection is the most common clinical manifestation. Although patients suffering from chronic lung diseases are particularly susceptible to NTM pulmonary disease, many affected patients have no apparent risk factors. Host and pathogen factors leading to NTM pulmonary disease are not well understood and preventive therapies are lacking. NTM isolation and pulmonary disease are reported to rise in frequency in Europe as well as in other parts of the world. Differentiation between contamination, infection, and disease remains challenging. Treatment of NTM pulmonary disease is arduous, lengthy, and costly. Correlations between results of in vitro antibiotic susceptibility testing and clinical treatment outcomes are only evident for the Mycobacterium avium complex, M. kansasii, and some rapidly growing mycobacteria. We describe the epidemiology of NTM pulmonary disease as well as emerging NTM pathogens and their geographical distribution in non-cystic fibrosis patients in Europe. We also review recent innovations for the diagnosis of NTM pulmonary disease, summarize treatment recommendations, and identify future research priorities to improve the management of patients affected by NTM pulmonary disease.

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Efficacy of Clarithromycin and Ethambutol for Mycobacterium avium Complex Pulmonary Disease. A Preliminary Study

Cited by 106 publications

References 18 publications

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

Clinical Characteristics, Treatment Outcomes, and Resistance Mutations Associated with Macrolide-Resistant Mycobacterium avium Complex Lung Disease

Peak Plasma Concentration of Azithromycin and Treatment Responses in Mycobacterium avium Complex Lung Disease

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

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