Factors Related to Response to Intermittent Treatment of Mycobacterium avium Complex Lung Disease

• Published in: American journal of respiratory and critical care medicine Vol. 173; no. 11; pp. 1283 - 1289
• Main Authors: Lam, Phung K, Griffith, David E, Aksamit, Timothy R, Ruoss, Stephen J, Garay, Stuart M, Daley, Charles L, Catanzaro, Antonino
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 01.06.2006; American Lung Association; American Thoracic Society
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antitubercular Agents - administration & dosage; Antitubercular Agents - adverse effects; Biological and medical sciences; Blood and lymphatic vessels; Bronchiectasis - drug therapy; Bronchiectasis - etiology; Cardiology. Vascular system; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Clarithromycin - administration & dosage; Clarithromycin - adverse effects; Clinical trials; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Double-Blind Method; Drug Therapy, Combination; Ethambutol - administration & dosage; Ethambutol - adverse effects; Female; Forced Expiratory Flow Rates; Forced Expiratory Volume; HIV; Human immunodeficiency virus; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Mycobacterium avium; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection - diagnostic imaging; Mycobacterium avium-intracellulare Infection - drug therapy; Patients; Physicians; Pneumology; Prospective Studies; Radiography; Response rates; Rifampin - administration & dosage; Rifampin - adverse effects; Sputum - microbiology; Tomography; Treatment Outcome; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - microbiology; United States > US; Lung disease; Intensive care; risk factors; Respiratory disease; Mycobacterium avium; clarithromycin; Mycobacterium avium complex; Treatment; Mycobacteriales; Intermittent; rifampin; ethambutol; Mycobacteriaceae; Bacteria; Actinomycetes; Resuscitation
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200509-1531OC

Mycobacterium avium complex pulmonary disease (MAC-PD) is associated with substantial morbidity, and standard daily multidrug therapy is difficult to tolerate. To characterize response to a three-times-weekly (TIW) regimen of clarithromycin, ethambutol, and rifampin. A 1-yr prospective noncomparative trial of TIW treatment was conducted during 2000-2003 in 17 U.S. cities. Participants were 91 HIV-negative adults, diagnosed with moderate to severe MAC-PD, who originally participated in a trial of an inhaled IFN-gamma treatment. Improvement in sputum culture, high-resolution computed tomography (HRCT), and symptoms were assessed. Treatment response rates (and median response times) were 44% (2 mo or longer) for culture, 60% (5.5-11.5 mo) for HRCT, and 53% (8.5 mo) for symptoms. Having noncavitary, compared with cavitary, disease increased culture response by 4.0 times (95% confidence interval [CI], 1.7-9.2) and HRCT response by 4.9 times (95% CI, 1.9-13.0). Culture response was 1.5 times (95% CI, 1.1-2.2) higher for older subjects and 2.2 times (95% CI, 1.0-4.7) higher for previously untreated subjects. Being smear-negative increased culture response by 2.3 times (95% CI, 1.1-5.2) but decreased HRCT response by 4.4 times (95% CI, 1.7-11.5). Increasing ethambutol use by 5 mo increased culture response by 1.5 times (95% CI, 1.0-2.1) but decreased symptom response. Not having chronic obstructive pulmonary disease, bronchiectasis, or poor lung function increased symptom response by 1.9 to 3.9 times. TIW therapy was less effective for MAC-PD patients with cavitary disease and a history of chronic obstructive pulmonary disease, bronchiectasis, or previous treatment for MAC-PD. Further research is needed to study the long-term outcomes of TIW treatment.