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Original Research: Chest Infections |

Macrolide/Azalide Therapy for Nodular/Bronchiectatic Mycobacterium avium Complex Lung DiseaseMycobacterium avium Complex Therapy

Richard J. Wallace, Jr, MD, FCCP; Barbara A. Brown-Elliott, MS; Steven McNulty, BS; Julie V. Philley, MD; Jessica Killingley, BS; Rebecca W. Wilson, BS; Deanna S. York, RN; Sara Shepherd, MS; David E. Griffith, MD, FCCP
Author and Funding Information

From the Department of Microbiology (Dr Wallace; Mss Brown-Elliott, Killingley, and York; and Mr McNulty), the Department of Medicine (Drs Wallace, Philley, and Griffith and Ms Brown-Elliott), and the Department of Pathology (Dr Wallace and Mss Wilson and Shepherd), University of Texas Health Science Center at Tyler, Tyler, TX.

CORRESPONDENCE TO: David E. Griffith, MD, FCCP, The University of Texas Health Science Center at Tyler, 11937 US Hwy 271, Tyler, TX 75708; e-mail: david.griffith@uthct.edu


FOR EDITORIAL COMMENT SEE PAGE 244

Data included in this manuscript were presented in part at the American Thoracic Society Annual Meeting, May 14-19, 2010, New Orleans, LA.

FUNDING/SUPPORT: This manuscript was supported in part by institutional funds from the University of Texas Health Science Center, Tyler and the Carter Foundation (Dr Wallace) and the Moncrief Foundation (Dr Griffith).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):276-282. doi:10.1378/chest.13-2538
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BACKGROUND:  There is no large study validating the appropriateness of current treatment guidelines for Mycobacterium avium complex (MAC) lung disease. This is a retrospective single-center review evaluating the efficacy of macrolide/azalide-containing regimens for nodular/bronchiectatic (NB) MAC lung disease.

METHODS:  Patients were treated according to contemporary guidelines with evaluation of microbiologic responses. Macrolide susceptibility of MAC isolates was done at initiation of therapy, 6 to 12 months during therapy, and on the first microbiologic recurrence isolate. Microbiologic recurrence isolates also underwent genotyping for comparison with the original isolates.

RESULTS:  One hundred eighty patients completed > 12 months of macrolide/azalide multidrug therapy. Sputum conversion to culture negative occurred in 154 of 180 patients (86%). There were no differences in response between clarithromycin or azithromycin regimens. Treatment regimen modification occurred more frequently with daily (24 of 30 [80%]) vs intermittent (2 of 180 [1%]) therapy (P = .0001). No patient developed macrolide resistance during treatment. Microbiologic recurrences during therapy occurred in 14% of patients: 73% with reinfection MAC isolates, 27% with true relapse isolates (P = .03). Overall, treatment success (ie, sputum conversion without true microbiologic relapse) was achieved in 84% of patients. Microbiologic recurrences occurred in 74 of 155 patients (48%) after completion of therapy: 75% reinfection isolates, 25% true relapse isolates.

CONCLUSIONS:  Current guidelines for macrolide/azalide-based therapies for NB MAC lung disease result in favorable microbiologic outcomes for most patients without promotion of macrolide resistance. Intermittent therapy is effective and significantly better tolerated than daily therapy. Microbiologic recurrences during or after therapy are common and most often due to reinfection MAC genotypes.


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