Effective treatment for clarithromycin-resistant Mycobacterium avium complex lung disease.
Aged
Antitubercular Agents
/ pharmacology
Clarithromycin
/ pharmacology
Drug Resistance, Bacterial
Drug Therapy, Combination
/ methods
Ethambutol
/ pharmacology
Female
Humans
Japan
Lung
/ diagnostic imaging
Lung Diseases
/ diagnosis
Male
Middle Aged
Mycobacterium avium Complex
/ drug effects
Mycobacterium avium-intracellulare Infection
/ diagnosis
Prognosis
Respiratory Tract Infections
/ diagnosis
Retrospective Studies
Rifampin
/ pharmacology
Sputum
/ microbiology
Tomography, X-Ray Computed
Treatment Outcome
Clarithromycin
Drug resistance
Ethambutol
Mycobacterium avium complex lung disease
Treatment
Journal
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
ISSN: 1437-7780
Titre abrégé: J Infect Chemother
Pays: Netherlands
ID NLM: 9608375
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
16
12
2019
revised:
05
02
2020
accepted:
18
02
2020
pubmed:
17
3
2020
medline:
7
4
2021
entrez:
16
3
2020
Statut:
ppublish
Résumé
Clinical management of macrolide-resistant Mycobacterium avium complex (MR-MAC) lung disease is difficult. To date, there only exist a limited number of reports on the treatment of clarithromycin-resistant MAC (CR-MAC) lung disease. This study aimed to evaluate prognostic factors and identify effective treatments in CR-MAC lung disease. We retrospectively collected clinical data of patients newly diagnosed with CR-MAC lung disease at the Kinki-Chuo Chest Medical Center between August 2010 and June 2018. Altogether, 37 patients with CR-MAC lung disease were enrolled. The median age was 69 years; 30, 22, and 21 patients received clarithromycin, ethambutol, and rifampicin, respectively, on their own or in drug combination. The observed sputum culture conversion rate was 29.7% (11/37 patients). In univariate analysis, ethambutol significantly increased the rate of sputum culture conversion (p = 0.027, odds ratio (OR) 10; 95% confidence interval (CI) 1.11-89.77). Multivariate analysis confirmed that ethambutol increased sputum culture conversion rate (p = 0.026; OR 21.8; 95% CI 1.45-329) while the existence of lung cavities decreased it (p = 0.04; OR 0.088; 95% CI 0.009-0.887). The combined use of ethambutol with other drugs may improve sputum culture conversion rate in CR-MAC lung disease.
Identifiants
pubmed: 32171660
pii: S1341-321X(20)30056-8
doi: 10.1016/j.jiac.2020.02.008
pii:
doi:
Substances chimiques
Antitubercular Agents
0
Ethambutol
8G167061QZ
Clarithromycin
H1250JIK0A
Rifampin
VJT6J7R4TR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
676-680Informations de copyright
Copyright © 2020 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None.