Kadota et al. BMC Infectious Diseases (2016) 16:31 DOI 10.1186/s12879-016-1384-7
RESEARCH ARTICLE
Open Access
Analysis of drug treatment outcome in clarithromycin-resistant Mycobacterium avium complex lung disease Tsukasa Kadota1,2*, Hirotoshi Matsui1, Takashi Hirose1, Junko Suzuki1, Minako Saito1, Tomohiro Akaba1, Kouichi Kobayashi1, Shunsuke Akashi1, Masahiro Kawashima1, Atsuhisa Tamura1, Hideaki Nagai1, Shinobu Akagawa1, Nobuyuki Kobayashi1 and Ken Ohta1,3
Abstract Background: Although the isolation of clarithromycin (CAM)-resistant Mycobacterium avium complex (MAC) indicates a poor treatment outcome and increased mortality, there have been only a few reports on drug treatment for CAM-resistant MAC lung disease. We aimed to reveal the effectiveness of the continuation of a macrolide and the use of a multidrug regimen in the treatment of CAM-resistant MAC lung disease. Methods: Among patients with MAC pulmonary disease as defined by the 2007 criteria of the American Thoracic Society and the Infectious Diseases Society of America statement, those with CAM-resistant MAC (minimum inhibitory concentration ≥32 μg/ml) isolated, newly diagnosed and treated from January 2009 to June 2013 were analysed in this study. Effectiveness was measured based on culture conversion rate and improvement of radiological findings. Results: Thirty-three HIV-negative patients were analysed in this study. Twenty-six were treated with a regimen containing CAM or azithromycin (AZM), and 21 patients were treated with three or more drugs except macrolide. The median duration to be evaluated was 10.4 months after beginning the treatment regimen. Sputum conversion (including cases of inability to expectorate sputum) was achieved in 12 (36 %) patients. Radiological effectiveness improved in 4 (12 %) patients, was unchanged in 11 (33 %) patients and worsened in 18 (55 %) patients. In the multivariate analysis, CRP
RESEARCH ARTICLE
Open Access
Analysis of drug treatment outcome in clarithromycin-resistant Mycobacterium avium complex lung disease Tsukasa Kadota1,2*, Hirotoshi Matsui1, Takashi Hirose1, Junko Suzuki1, Minako Saito1, Tomohiro Akaba1, Kouichi Kobayashi1, Shunsuke Akashi1, Masahiro Kawashima1, Atsuhisa Tamura1, Hideaki Nagai1, Shinobu Akagawa1, Nobuyuki Kobayashi1 and Ken Ohta1,3
Abstract Background: Although the isolation of clarithromycin (CAM)-resistant Mycobacterium avium complex (MAC) indicates a poor treatment outcome and increased mortality, there have been only a few reports on drug treatment for CAM-resistant MAC lung disease. We aimed to reveal the effectiveness of the continuation of a macrolide and the use of a multidrug regimen in the treatment of CAM-resistant MAC lung disease. Methods: Among patients with MAC pulmonary disease as defined by the 2007 criteria of the American Thoracic Society and the Infectious Diseases Society of America statement, those with CAM-resistant MAC (minimum inhibitory concentration ≥32 μg/ml) isolated, newly diagnosed and treated from January 2009 to June 2013 were analysed in this study. Effectiveness was measured based on culture conversion rate and improvement of radiological findings. Results: Thirty-three HIV-negative patients were analysed in this study. Twenty-six were treated with a regimen containing CAM or azithromycin (AZM), and 21 patients were treated with three or more drugs except macrolide. The median duration to be evaluated was 10.4 months after beginning the treatment regimen. Sputum conversion (including cases of inability to expectorate sputum) was achieved in 12 (36 %) patients. Radiological effectiveness improved in 4 (12 %) patients, was unchanged in 11 (33 %) patients and worsened in 18 (55 %) patients. In the multivariate analysis, CRP
