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Original Research |

Oral Macrolide Therapy Following Short-term Combination Antibiotic Treatment for Mycobacterium massiliense Lung Disease

Won-Jung Koh, MD; Byeong-Ho Jeong, MD; Kyeongman Jeon, MD; Su-Young Kim, PhD; Kyoung Un Park, MD; Hye Yun Park, MD; Hee Jae Huh, MD; Chang-Seok Ki, MD; Nam Yong Lee, MD; Seung-Heon Lee, PhD; Chang Ki Kim, MD; Charles L. Daley, MD; Sung Jae Shin, PhD; Hojoong Kim, MD; O Jung Kwon, MD
Author and Funding Information

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

Funding information: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and future Planning (NRF-2015R1A2A1A01003959) and by a grant of the Korea Health technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI15C2778).

Correspondence to: Won-Jung Koh, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, South Korea.


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.05.003
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Abstract

Background  Although Mycobacterium massiliense lung disease is increasing in patients with cystic fibrosis and non-cystic fibrosis bronchiectasis, optimal treatment regimens remain largely unknown. This study aimed to evaluate the efficacy of oral macrolide therapy after an initial two-week course of combination antibiotics for treating of M. massiliense lung disease.

Methods  Seventy-one patients received oral macrolides, along with an initial four-week (n = 28) or two-week (n = 43) intravenous (IV) amikacin and cefoxitin (or imipenem) treatment. These patients were treated for 24 months (4-week IV group) or for at least 12 months after negative sputum culture conversion (2-week IV group).

Results  Total treatment duration was longer in the 4-week IV group (median 23.9 months) than in the 2-week IV group (15.2 months, P < .001). The response rates after 12 months of treatment were 89% for symptoms, 79% for computed tomography, and 100% for negative sputum cultures in the 4-week IV group. In the 2-week IV group, these values were 100% (P = .057), 91% (P = .177), and 91% (P = .147) respectively. Acquired macrolide resistance developed in two patients in the 2-week IV group. Genotyping analyses of isolates from patients who failed to convert sputum culture to negative during treatment and from those who has positive culture after successful treatment completion revealed that most episodes were due to reinfection with different genotypes of M. massiliense.

Conclusions  Oral macrolide therapy after an initial two-week course of combination antibiotics might be effective in most patients with M. massiliense lung disease.


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