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Original Research: Chest Infections |

Oral Macrolide Therapy Following Short-term Combination Antibiotic Treatment of 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

W.-J. K., B.-H. J., and K. J. contributed equally to this work.

FUNDING/SUPPORT: 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 from 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).

aDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

bDepartment of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, and Seoul National University College of Medicine, Seoul, South Korea

cDepartment of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

dKorean Institute of Tuberculosis, Cheongju, South Korea

eDivision of Mycobacterial and Respiratory Infections, Department of Medicine, National Jewish Health, Denver, Colorado

fDepartment of Microbiology, Yonsei University College of Medicine, Seoul, South Korea

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;150(6):1211-1221. doi:10.1016/j.chest.2016.05.003
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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 2-week course of combination antibiotics for the treatment of M massiliense lung disease.

Methods  Seventy-one patients received oral macrolides, along with an initial 4-week (n = 28) or 2-week (n = 43) 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 CT scanning, and 100% for negative sputum culture results 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 did not achieve negative sputum culture conversion during treatment and from those with positive culture results 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 2-week course of combination antibiotics might be effective in most patients with M massiliense lung disease.

Trial registry  ClinicalTrials.gov; No.: NCT00970801; URL: www.clinicaltrials.gov.

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