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Original Research: RESPIRATORY INFECTIONS |

Therapeutic Effects of Various Initial Combinations of Chemotherapy Including Clarithromycin Against Mycobacterium avium Complex Pulmonary Disease

Naoki Hasegawa, MD; Tomoyasu Nishimura, MD; Sumire Ohtani, MD; Kei Takeshita, MD; Koichi Fukunaga, MD; Sadatomo Tasaka, MD, FCCP; Tetsuya Urano, MD; Koudou Ishii, MD; Mamoru Miyairi, MD; Akitoshi Ishizaka, MD, FCCP
Author and Funding Information

Affiliations: From the Division of Pulmonary Medicine (Drs. Hasegawa, Nishimura, Takeshita, Fukunaga, Tasaka, and Ishizaka), Department of Medicine, Keio University School of Medicine, Tokyo, Japan; the Department of Medicine (Dr. Nishimura), Sano Kohsei General Hospital, Tochigi, Japan; the Department of Medicine (Drs. Ohtani, Ishii, and Miyairi), National Minami-Yokohama Hospital, Kanagawa, Japan; the Department of Medicine (Dr. Takeshita), Kitasato Institute Hospital, Tokyo, Japan; the Department of Medicine (Dr. Fukunaga), Saitama Social Insurance Hospital, Saitama, Japan; and the Division of Pulmonary Medicine (Dr. Urano), Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan.

Correspondence to: Naoki Hasegawa, MD, 35 Shinanomachi Shinjyuku-ku, Tokyo, Japan 160-8582; e-mail: hasegawn@sc.itc.keio.ac.jp


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1569-1575. doi:10.1378/chest.08-2567
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Background:  The objective of this study was to find an optimal initial combination chemotherapy that includes clarithromycin (CAM) for treatment-naive patients with Mycobacterium avium complex (MAC) pulmonary disease, as assessed by microbiological conversion using a Mycobacterium growth indicator tube (MGIT).

Methods:  Thirty-four patients with treatment-naive MAC pulmonary disease (determined using 1997 American Thoracic Society criteria) were evaluated retrospectively. They demonstrated a nodular and bronchiectatic pattern without cavity on high-resolution CT (HRCT) scans. The following three regimens were administered: regimen A (n = 9) consisted of CAM (400 mg/d), ethambutol (EB) [750 mg/d], and rifampicin (RFP) [450 mg/d]; regimen B (n = 12) consisted of CAM (800 mg/d), EB (750 mg/d), and RFP (450 mg/d); and regimen C (n = 13) consisted of CAM (800 mg/d), EB (1,000 mg/d), and RFP (600 mg/d) during the first 2 months followed by a reduction of the dosage of EB from 1,000 to 750 mg/d. Gender, age, BMI, and HRCT scan finding scores were not significantly different among the three groups. Chemotherapy was continued for 18 months. Sputum culture was periodically assessed by MGIT.

Results:  Culture conversion at 18 months in regimen A (55.6%), which included a daily dosage of 400 mg of CAM (9.5 mg/kg), was significantly inferior to that in regimen B (91.7%), which included daily 800 mg of CAM (17.6 mg/kg; p < 0.05), but regimen B and C (92.3%) showed no between-group difference after > 18 months of chemotherapy.

Conclusions:  The higher dose of CAM allowed for better culture conversion. Daily combination chemotherapy that includes CAM (800 mg) seems appropriate as an initial treatment against treatment-naive patients with nodular and bronchiectatic MAC pulmonary disease.


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