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J Infect Chemother. 2018 Aug 29. pii: S1341-321X(18)30242-3. doi: 10.1016/j.jiac.2018.07.021. [Epub ahead of print]

Efficacy and safety of intermittent maintenance therapy after successful treatment of Mycobacterium avium complex lung disease.

Author information

1
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
2
Department of Pulmonary Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan.
3
Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
4
Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Japan. Electronic address: n-hasegawa@z8.keio.jp.

Abstract

BACKGROUND:

The optimal duration of antimicrobial therapy for Mycobacterium avium complex lung disease (MAC-LD) is unknown, and recurrence rates are high after treatment discontinuation. Intermittent therapy is recommended for the initial treatment of non-cavitary nodular/bronchiectatic MAC-LD. We hypothesized that intermittent maintenance therapy (IMT) could effectively prevent recurrence after successful treatment of MAC-LD.

METHODS:

Adult patients diagnosed with MAC-LD who received IMT after successful daily therapy (DT) between January 1, 2006 and December 31, 2016 were identified from clinical databases at three institutions in Japan. Treatment outcomes were evaluated for all patients.

RESULTS:

Of 38 patients (median age, 66 years; 29 women; nodular/bronchiectatic form, 29 patients) who received IMT after successful treatment, one was excluded due to death from an unknown cause, 1 month after IMT initiation. Finally, treatment outcomes were evaluated for 37 patients. Twenty-eight (76%) patients had sustained negative culture results over a median follow-up duration of 2.7 (interquartile range [IQR], 1.9-6.0) years, while six (16%) required switching to DT because of clinical deterioration over a median follow-up duration of 2.7 (IQR, 1.6-4.1) years. Favorable clinical outcomes were achieved for all patients who exhibited clinical deterioration. All patients tolerated the antimicrobials without discontinuation, and follow-up drug susceptibility testing showed negative results for clarithromycin-resistant MAC in the patients who experienced clinical deterioration.

CONCLUSIONS:

IMT after successful treatment may be a feasible option for patients with MAC-LD. Further studies should determine the population that would benefit from this strategy.

KEYWORDS:

Intermittent maintenance therapy (IMT); Mycobacterium avium complex (MAC); Nontuberculous mycobacteria (NTM); Pulmonary disease

PMID:
30172726
DOI:
10.1016/j.jiac.2018.07.021

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