Macrolide resistant Mycobacterium avium complex pulmonary disease following clarithromycin and ethambutol combination therapy - 03/08/20
, Seiichi Miwa a, 1, Masahiro Shirai a, Miho Kanai a, Kaoru Fujita a, Hisano Ohba a, Eriko Iwaizumi a, Tomoko Oshima a, Suguru Kojima a, Takafumi Suda b, Hiroshi Hayakawa aAbstract |
Rationale |
Whether two-drug therapy (clarithromycin and ethambutol) for Mycobacterium avium complex (MAC) pulmonary disease contributes to the development of macrolide-resistant MAC is unclear.
Objective |
To compare the incidence of macrolide-resistant MAC between patients treated with two-drug therapy (clarithromycin and ethambutol) and the standard three-drug therapy (clarithromycin, ethambutol, and rifampicin) for MAC pulmonary disease.
Methods |
We retrospectively reviewed 147 patients with treatment-naive MAC pulmonary disease who had received two-drug therapy (n = 47) or three-drug therapy (n = 100) between 1997 and 2016 at National Hospital Organization, Tenryu Hospital, Hamamatsu, Japan. The risk of development of macrolide-resistant MAC was evaluated by calculating the cumulative incidence rate using Gray's test.
Results |
The median follow-up period was 74.5 months. During the follow-up period, one of the 47 patients (2.1%) in the two-drug group developed macrolide-resistant MAC, compared to 12 of the 100 patients (12.0%) in the three-drug group. The cumulative incidence rate of macrolide-resistant MAC was lower in the two-drug group than in the three-drug group (0.0023; 95% confidence interval, 0.002 to 0.107 versus 0.200; 95% confidence interval, 0.100 to 0.324, p = 0.0593).
Conclusions |
These results suggest that two-drug treatment with clarithromycin and ethambutol for MAC pulmonary disease does not lead to a higher incidence of resistance acquisition to clarithromycin than the standard three-drug treatment.
Le texte complet de cet article est disponible en PDF.Highlights |
• | CLR and EMB therapy for MAC-PD did not increase macrolide-resistant MAC. |
• | Rate of discontinuation of CLR and EMB therapy due to adverse events was low. |
• | CLR and EMB therapy may be a useful alternative to the standard regimen for MAC-PD. |
Keywords : Mycobacterium avium-intracellulare complex, Antibiotic resistance, Clarithromycin
Abbreviations : AFB, ATS, CI, HIV, HR, HRCT, IDSA, IQR, MAC
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Vol 169
Article 106025- août 2020 Retour au numéro
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