Macrolide-resistant mycobacterium avium complex lung disease: Analysis of 102 consecutive cases

Nontuberculous Mycobacteriosis Japan Research Consortium

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Rationale: The management of macrolide-resistant Mycobacterium aviumcomplex (MR-MAC)pulmonary disease is difficult and is thought to be analogous to that of multidrug-resistant tuberculosis (MDR-TB). Objectives: This study aimed to clarify the cause of MR-MAC, to see how its management affected outcome, and to compare its prognosis with that of MDR-TB. Methods: The medical records of 102 consecutive cases with MR-MACpulmonary disease at three tertiary hospitals for mycobacteriosis in metropolitan Tokyo and one in Aichi prefecture from 2005 to 2014were reviewed.The data of 311 consecutive caseswith MDR-TB were extracted from the medical data at Fukujuji Hospital. Measurements and Main Results: Of the 90 patients who met the criteria, 53 (58.9%) received inappropriate first-line treatment, and 28 (31.1%) deviated from the standard treatment because of the adverse effects of ethambutol. The survival rates for MR-MAC disease and MDR-TB were not significantly different (P = 0.6). Multivariate analysis showed that the combination of aminoglycoside and surgery resulted in the best treatment outcome (P = 0.02), although neither of the two factors reached significance by themselves. The continuation of clarithromycin and the addition of fluoroquinolones did not improve the outcome for the treatment of disease caused by MR-MAC. Conclusions: Inappropriate prescription patterns and deviations from the standard treatment because of adverse drug reactions appeared to be the main causes of macrolide resistance in this patient series. Drug sensitivity testing should be performed at diagnosis to identify macrolide resistance and patients who may benefit from other therapy.

Original languageEnglish
Pages (from-to)1904-1911
Number of pages8
JournalAnnals of the American Thoracic Society
Volume13
Issue number11
DOIs
Publication statusPublished - 2016 Nov 1

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Mycobacterium avium Complex
Macrolides
Lung Diseases
Multidrug-Resistant Tuberculosis
Mycobacterium
Inappropriate Prescribing
Ethambutol
Clarithromycin
Tokyo
Fluoroquinolones
Aminoglycosides
Therapeutics
Drug-Related Side Effects and Adverse Reactions
Tertiary Care Centers
Medical Records
Multivariate Analysis
Survival Rate
Pharmaceutical Preparations

Keywords

  • Clarithromycin
  • Multidrug-resistant tuberculosis
  • Prognosis
  • Side effect

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine

Cite this

Macrolide-resistant mycobacterium avium complex lung disease : Analysis of 102 consecutive cases. / Nontuberculous Mycobacteriosis Japan Research Consortium.

In: Annals of the American Thoracic Society, Vol. 13, No. 11, 01.11.2016, p. 1904-1911.

Research output: Contribution to journalArticle

Nontuberculous Mycobacteriosis Japan Research Consortium. / Macrolide-resistant mycobacterium avium complex lung disease : Analysis of 102 consecutive cases. In: Annals of the American Thoracic Society. 2016 ; Vol. 13, No. 11. pp. 1904-1911.
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abstract = "Rationale: The management of macrolide-resistant Mycobacterium aviumcomplex (MR-MAC)pulmonary disease is difficult and is thought to be analogous to that of multidrug-resistant tuberculosis (MDR-TB). Objectives: This study aimed to clarify the cause of MR-MAC, to see how its management affected outcome, and to compare its prognosis with that of MDR-TB. Methods: The medical records of 102 consecutive cases with MR-MACpulmonary disease at three tertiary hospitals for mycobacteriosis in metropolitan Tokyo and one in Aichi prefecture from 2005 to 2014were reviewed.The data of 311 consecutive caseswith MDR-TB were extracted from the medical data at Fukujuji Hospital. Measurements and Main Results: Of the 90 patients who met the criteria, 53 (58.9{\%}) received inappropriate first-line treatment, and 28 (31.1{\%}) deviated from the standard treatment because of the adverse effects of ethambutol. The survival rates for MR-MAC disease and MDR-TB were not significantly different (P = 0.6). Multivariate analysis showed that the combination of aminoglycoside and surgery resulted in the best treatment outcome (P = 0.02), although neither of the two factors reached significance by themselves. The continuation of clarithromycin and the addition of fluoroquinolones did not improve the outcome for the treatment of disease caused by MR-MAC. Conclusions: Inappropriate prescription patterns and deviations from the standard treatment because of adverse drug reactions appeared to be the main causes of macrolide resistance in this patient series. Drug sensitivity testing should be performed at diagnosis to identify macrolide resistance and patients who may benefit from other therapy.",
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AU - Nontuberculous Mycobacteriosis Japan Research Consortium

AU - Morimoto, Kozo

AU - Namkoong, Ho

AU - Hasegawa, Naoki

AU - Nakagawa, Taku

AU - Morino, Eriko

AU - Shiraishi, Yuji

AU - Ogawa, Kenji

AU - Izumi, Kiyohiko

AU - Takasaki, Jin

AU - Yoshiyama, Takashi

AU - Hoshino, Yoshihiko

AU - Matsuda, Shuichi

AU - Hayashi, Yuta

AU - Sasaki, Yuka

AU - Ishii, Makoto

AU - Kurashima, Atsuyuki

AU - Nishimura, Tomoyasu

AU - Betsuyaku, Tomoko

AU - Goto, Hajime

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N2 - Rationale: The management of macrolide-resistant Mycobacterium aviumcomplex (MR-MAC)pulmonary disease is difficult and is thought to be analogous to that of multidrug-resistant tuberculosis (MDR-TB). Objectives: This study aimed to clarify the cause of MR-MAC, to see how its management affected outcome, and to compare its prognosis with that of MDR-TB. Methods: The medical records of 102 consecutive cases with MR-MACpulmonary disease at three tertiary hospitals for mycobacteriosis in metropolitan Tokyo and one in Aichi prefecture from 2005 to 2014were reviewed.The data of 311 consecutive caseswith MDR-TB were extracted from the medical data at Fukujuji Hospital. Measurements and Main Results: Of the 90 patients who met the criteria, 53 (58.9%) received inappropriate first-line treatment, and 28 (31.1%) deviated from the standard treatment because of the adverse effects of ethambutol. The survival rates for MR-MAC disease and MDR-TB were not significantly different (P = 0.6). Multivariate analysis showed that the combination of aminoglycoside and surgery resulted in the best treatment outcome (P = 0.02), although neither of the two factors reached significance by themselves. The continuation of clarithromycin and the addition of fluoroquinolones did not improve the outcome for the treatment of disease caused by MR-MAC. Conclusions: Inappropriate prescription patterns and deviations from the standard treatment because of adverse drug reactions appeared to be the main causes of macrolide resistance in this patient series. Drug sensitivity testing should be performed at diagnosis to identify macrolide resistance and patients who may benefit from other therapy.

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KW - Clarithromycin

KW - Multidrug-resistant tuberculosis

KW - Prognosis

KW - Side effect

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