Actual practice of standard treatment for pulmonary nontuberculous mycobacteriosis in Japan

• Published in: Respiratory medicine Vol. 158; pp. 67 - 69
• Main Authors: Morimoto, Kozo, Izumi, Kiyohiko, Ato, Manabu, Hasegawa, Naoki, Mitarai, Satoshi
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2019; Elsevier Limited
• Subjects: Antibiotics; Clarithromycin resistant; Disease; Drug therapy; Guideline; Insurance claim; Lung diseases; Mortality; Mycobacteriosis; Patients; R&D; Research & development; Treatment; United States > US; Japan; Guideline; Clarithromycin resistant; Treatment; Insurance claim
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2019.10.002

The details of the practice of treating nontuberculous mycobacterial pulmonary disease (NTMPD) have not been studied in Japan. We studied a random sample of 2% (184) of the 9,200 patients with incident NTM-PD in 2010 who received standard three-drug therapy for at least some of their treatment between 2010 and 2014. The median duration of the standard treatment period was 248 days (IQR 56–540 days). Although 59% of the patients were treated with standard therapy for more than 6 months, only 41% were treated for 12 months. Fifty-three patients (29%) initiated treatment with substandard regimen, and 18 (34%) of those patients received treatment regimens that can lead to the development of macrolide resistance (MR)(CLR monotherapy or CLR + RIF). Furthermore, initially, 184 receiving the standard treatment, 49 patients (27%) eventually deviated from it, and 31 patients (63%) received regimens increasing the risk of developing MR. The sporadic administration of macrolide monotherapy was observed before and after the administration of the standard treatment for 50 patients (27.7%) and 41 patients (27.2%), respectively. Approximately 60% of the treated patients did not continue the standard regimen for more than 12 months and 42% were at risk for developing MR before and after receiving the standard treatment. It is important to educate physicians and patients about the correct and safe management of NTMPD. •Only 40% of the NTM-PD were treated >12 months with the standard regimens in Japan.•Among the 27% of cases who changed the regimen, 63% had risk of macrolide resistance.•Macrolides monotherapy were frequently prescribed even after registered as NTM-PD.•Cessation of EMB due to side effect could be the cause of deviation from the standard.•Countermeasures, including educational efforts and local guidelines, are essential.