Use of mefloquine in multidrug-resistant Mycobacterium avium complex pulmonary disease in an HIV-negative patient

• Published in: Current therapeutic research Vol. 68; no. 6; pp. 421 - 429
• Main Authors: Ramirez, Juan, MD, Mason, Carol, MD, FCCP, Ali, Juzar, MD, FRCP(C), FCCP
• Format: Journal Article
• Language: English
• Published: Belle Mead, NJ EM Inc USA 01.11.2007; Excerpta medica; Elsevier
• Subjects: acid-fast bacillus; Biological and medical sciences; bronchiectasis; Human viral diseases; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Internal Medicine; macrolide-resistant Mycobacterium avium complex; Medical Education; Medical sciences; mefloquine; multidrug-resistant; mycobacteria; Mycobacterium avium complex; Mycobacterium avium complex pulmonary disease; nontuberculous mycobacteria; Pharmacology. Drug treatments; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Mycobacterium avium complex; Mycobacterium avium complex pulmonary disease; nontuberculous mycobacteria; macrolide-resistant Mycobacterium avium complex; acid-fast bacillus; bronchiectasis; mycobacteria; mefloquine; multidrug-resistant; Antimalarial; Bacillaceae; Bacillales; Multiple resistance; Bacillus; Bacteria; Bronchus disease; Protein synthesis inhibitor; Human; Immunopathology; Lung disease; Mefloquine; Respiratory disease; Mycobacterium avium; AIDS; Bronchiectasis; Immune deficiency; Macrolide; Infection; Acids; Mycobacteriales; Viral disease; Mycobacteriaceae; Parasiticide; Actinomycetes
• ISSN: 0011-393X; 1879-0313
• DOI: 10.1016/j.curtheres.2007.12.005

AbstrAct Introduction : Mycobacterium avium complex (MAC) is a leading cause of pulmonary disease (PD), even in those with intact immunity, representing about 30% of the cases of pleuropulmonary mycobacterial infection. Based on previous studies, macrolides are the only agents used in the treatment of MAC disease for which there is a correlation between in vitro susceptibility and in vivo (clinical) response. However, resistance develops rapidly if single-agent treatment is used. Data regarding treatment of macrolide-resistant MAC (MRMAC) and multidrug-resistant MAC (MDRMAC) are sparse. Case summary : A 50-year-old, HIV-negative white man, weighing 53.6 kg, with severe chronic obstructive pulmonary disease and bronchiectasis was initially on treatment for MAC-PD and MRMAC. The patient was followed between 1999 and 2006. His treatment history revealed that in addition to the multiple drugs administered during the course of his illness, thalidomide, interferon-γ, and mefloquine were also administered. The patient died ~7 years later due to respiratory failure and overwhelming infection Conclusions : This case report describes the use of mefloquine as adjunct treatment in an HIV-negative patient with MDRMAC-PD and discusses the associated outcomes of drug resistance.