Chest Infections |

Monotherapy With Erythromycin for Mycobacterium avium Complex Pulmonary Disease FREE TO VIEW

Yukihiro Yano, PhD; Seigo Kitada, PhD; Masahide Mori, PhD; Soichiro Yokota, PhD; Ryoji Maekura, PhD
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Toneyama National Hospital, Toyonaka, Japan

Chest. 2014;145(3_MeetingAbstracts):131A. doi:10.1378/chest.1787848
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SESSION TITLE: Tuberculosis Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: The efficacy of standard chemotherapy for Mycobacterium avium complex pulmonary disease (MAC-PD) is limited by poor clinical response rate, drug toxicity and side effects. When to start standard chemotherapy or which patients to treat remains undefined. In Japan, patients with MAC-PD are sometimes treated with erythromycin alone as an alternative therapy before or after standard chemotherapy to prevent disease progression. The rationale for this is that erythromycin has immunomodulatory properties independent of its antimicrobial effects. To date, however, monotherapy with erythromycin for MAC-PD is not well established. Therefore we investigated the safety, tolerability and possible clinical benefit of this treatment.

METHODS: A retrospective observational study was conducted on MAC-PD patients who had received monotherapy with erythromycin for more than a month. Their medical records were reviewed, including data on age, gender, radiographic findings, treatment regimen, treatment period, adverse effects and treatment efficacy. We also investigated susceptibility to clarithromycin twice in those patients with data available before and after the beginning of treatment.

RESULTS: A total of 61 patients was included with median erythromycin monotherapy of 18 months duration. Fifty-one patients (83.6%) achieved disease control and 8 progressed (13.1%), of whom 4 had had preexisting resistance to clarithromycin. Five (8.2%) had mild to moderate adverse effects. Susceptibility to clarithromycin could be assessed twice in 32 patients. The median time from the beginning of erythromycin treatment to the second clarithromycin susceptibility test was 10 months. There was no acquisition of clarithromycin resistance during the study period.

CONCLUSIONS: Monotherapy with erythromycin was useful for achieving disease control and relatively non-toxic, and it did not induce clarithromycin resistance. Further long-term investigation is needed to evaluate clinical benefit.

CLINICAL IMPLICATIONS: Monotherapy with erythromycin may be safe, well-tolerated and useful for stabilizing MAC-PD.

DISCLOSURE: The following authors have nothing to disclose: Yukihiro Yano, Seigo Kitada, Masahide Mori, Soichiro Yokota, Ryoji Maekura

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