Intermittent Treatment with Azithromycin and Ethambutol for Noncavitary Mycobacterium avium Complex Pulmonary Disease

ABSTRACT We evaluated the efficacy of intermittent azithromycin and ethambutol therapy for noncavitary Mycobacterium avium complex pulmonary disease (MAC-PD). Twenty-nine (76%) of 38 patients achieved sputum culture conversion after 12 months of treatment, and sputum smear positivity was an independent factor for failure to achieve culture conversion (adjusted odds ratio, 26.7; 95% confidence interval, 2.1 to 339.9; P = 0.011). Intermittent azithromycin and ethambutol may be an optional treatment regimen for noncavitary MAC-PD.

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Multicentre, open label, randomised controlled trial comparing intermittent versus daily treatment for non-cavitary nodular/bronchiectatic Mycobacterium avium complex lung disease with rifampicin, ethambutol and clarithromycin (iREC): study protocol

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000434 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000434 ◽

Cited By ~ 2

Author(s):

Taku Nakagawa ◽

Hiroya Hashimoto ◽

Mitsuaki Yagi ◽

Yoshihito Kogure ◽

Masahiro Sekimizu ◽

...

Keyword(s):

Treatment Group ◽

Lung Disease ◽

Treatment Regimen ◽

Mycobacterium Avium ◽

Drug Combination ◽

Daily Treatment ◽

Intermittent Treatment ◽

Sputum Culture Conversion ◽

Randomised Controlled ◽

Culture Conversion

IntroductionStandard treatment for nodular/bronchiectatic Mycobacterium avium complex lung disease (NB MAC-LD), excluding severe-status cases, differs between Japan and other countries. Internationally, three-drug combination intermittent treatment (three times a week administration) with macrolide, ethambutol and rifampicin is recommended, but a daily treatment regimen is recommended in Japan. To date, no randomised controlled study directly comparing intermittent treatment with daily treatment has been performed. The purpose of this study is to investigate the usefulness of intermittent treatment.Methods and analysisA total of 140 patients diagnosed with NB MAC-LD in Japan will be randomly assigned, in a 1:1 ratio, to intermittent treatment group or daily treatment group, and three-drug combination therapy with clarithromycin, rifampicin and ethambutol will be continued for 1 year. The primary endpoint is the proportion of patients requiring modification of the initial treatment regimen. Secondary endpoints are adverse events, sputum culture conversion, time to sputum culture conversion, improvement of chest CT findings, change in health-related quality of life score and development of clarithromycin resistance.Ethics and disseminationThis trial was approved by the National Hospital Organisation Review Board for Clinical Trials (Headquarters). The results of this study will be reported at a society meeting or published in a peer-review journal.

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Levels of Antibody against Glycopeptidolipid Core as a Marker for Monitoring Treatment Response in Mycobacterium avium Complex Pulmonary Disease: a Prospective Cohort Study

Journal of Clinical Microbiology ◽

10.1128/jcm.02010-16 ◽

2016 ◽

Vol 55 (3) ◽

pp. 884-892 ◽

Cited By ~ 13

Author(s):

Seigo Kitada ◽

Ryoji Maekura ◽

Kenji Yoshimura ◽

Keisuke Miki ◽

Mari Miki ◽

...

Keyword(s):

Pulmonary Disease ◽

Mycobacterium Avium ◽

Serum Levels ◽

Chemotherapy Response ◽

Content Type ◽

Therapeutic Outcomes ◽

Significant Difference ◽

Antibody Levels ◽

Culture Conversion ◽

Percent Decrease

ABSTRACT The diagnosis of Mycobacterium avium complex pulmonary disease (MAC-PD) is sometimes complicated and time-consuming. A serodiagnostic kit that measures the serum levels of IgA antibodies against the glycopeptidolipid (GPL) core is commercially available and has good diagnostic accuracy for MAC-PD. However, the significance of measurement of GPL core IgA antibody levels in monitoring for chemotherapy response in patients with MAC-PD was not well investigated. Thirty-four treatment naive MAC-PD patients who were started on multidrug chemotherapy were enrolled. Their antibody levels were prospectively measured at regular intervals. The relationships between their antibody levels and the therapeutic outcomes were examined. The patients were classified into three groups (conversion, recurrence, and nonconversion) based on the bacteriological outcomes after chemotherapy. There were no significant differences in the antibody levels before treatment between the culture conversion ( n = 19), recurrence ( n = 7), and nonconversion ( n = 8) groups ( P = 0.9881). The levels decreased significantly after the chemotherapy ( P < 0.0001). Recurrence and/or worsening of chest radiography findings were observed in cases whose antibody levels subsequently increased after cessation of the chemotherapy. No significant difference in the percent decrease in antibody levels by the chemotherapy was observed between the culture conversion and recurrence groups ( P = 0.9338). The initial antibody levels are not a predictor of therapeutic outcomes, and also the percent decrease in antibody levels is not a sufficient indicator of the cessation of chemotherapy. However, serial measurements of antibody levels may allow objective monitoring of disease activity in individual MAC-PD patients.

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RELATIONSHIP BETWEEN IN VITRO CLARITHROMYCIN SUSCEPTIBILITY AND SPUTUM CULTURE CONVERSION WITH ADD-ON AMIKACIN LIPOSOME INHALATION SUSPENSION (ALIS) FOR TREATMENT OF REFRACTORY MYCOBACTERIUM AVIUM COMPLEX (MAC) LUNG DISEASE

CHEST Journal ◽

10.1016/j.chest.2018.08.095 ◽

2018 ◽

Vol 154 (4) ◽

pp. 109A-110A

Author(s):

DAVID GRIFFITH ◽

GINA EAGLE ◽

RICHARD WALLACE ◽

BARBARA BROWN-ELLIOTT ◽

JAKKO VAN INGEN ◽

...

Keyword(s):

Lung Disease ◽

Mycobacterium Avium ◽

Mycobacterium Avium Complex ◽

Sputum Culture ◽

Sputum Culture Conversion ◽

Culture Conversion

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Surgical Resection Compared to Medical Management in localized Mycobacteria Avium Complex Pulmonary Infections-A Case Control Study

10.21203/rs.3.rs-122939/v1 ◽

2020 ◽

Author(s):

Gabriel Fregoso ◽

Rakesh Dhiman ◽

Michael Lanuti ◽

John Wain ◽

Rocio Hurtado ◽

...

Keyword(s):

Pulmonary Disease ◽

Surgical Resection ◽

Mycobacterium Avium ◽

Medical Management ◽

Odds Ratio ◽

Mycobacterium Avium Complex ◽

Lung Resection ◽

Case Series ◽

Case Control ◽

Pulmonary Infections

Abstract Background Pulmonary infections associated with Mycobacterium avium complex can be challenging to treat medically and the role of surgical lung resection is not well established. We aim to assess safety and microbiologic response in patient with localized Mycobacterium avium complex pulmonary infections managed with surgical lung resection compared to medical management alone. Methods We present a multi-institutional case series of 16 patients with localized Mycobacterium avium complex pulmonary infections managed with surgical lung resection. We highlight the case of a 30 to 40-year-old patient with localized pulmonary disease amenable to surgical resection for illustrative purposes and report on outcomes compared with medically treated patients at the same institution in case-control design. Results Of 745 patients meeting microbiologic diagnostic criteria for Mycobacterium avium complex pulmonary infections, 98 had localized pulmonary disease and of these 16 underwent surgical resection. Univariate and multivariate analysis results indicated no difference in surgical resection group compared with medical treatment: microbiologic response rate (odds ratio 0.49, 0.1–2.41), 2-year all-cause mortality (odds ratio 0.87, 0.18–4.32), and composite outcome of 2-year mortality and lack of microbiological response (multivariate logistic regression OR = 0.45, 0.09–1.57). Conclusions This case series describes patients with localized pulmonary Mycobacterium avium complex for whom surgical resection was pursued and shows examples of patients that may benefit from surgery. Though surgery for pulmonary Mycobacterium avium complex disease is rarely performed, it appears as safe and at least as effective as medical-therapy alone.

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