Treatment of Mycobacterium abscessus pulmonary
infection requires long-term administration of multiple
antibiotics. Little is known, however, about the impact of each
antibiotic on treatment outcomes. A retrospective analysis was conducted to evaluate the efficacy and adverse effects of
antibiotics administered in 244 cases of M. abscessus
pulmonary disease. Only 110 (45.1%) patients met the criteria for treatment success. The efficacy of treating M. abscessus
pulmonary disease continues to be unsatisfactory especially for
infections involving M. abscessus subsp. abscessus. Treatment with
drug combinations that included
amikacin [adjusted odds ratio (AOR), 3.275; 95% confidence interval (CI), 1.221-8.788],
imipenem (AOR, 2.078; 95% CI, 1.151-3.753),
linezolid (AOR, 2.231; 95% CI, 1.078-4.616), or
tigecycline (AOR, 2.040; 95% CI, 1.079-3.857) was successful. Adverse side effects affected the majority of patients (192/244, 78.7%). Severe effects that resulted in treatment modification included: gastrointestinal distress (29/60, 48.3%) mostly caused by
tigecycline,
ototoxicity (14/60, 23.3%) caused by
amikacin; and myelosuppression (6/60, 10%) caused mainly by
linezolid. In conclusion, the success rate of treatment of M. abscessus
pulmonary disease is still unsatisfactory. The administration of
amikacin,
imipenem,
linezolid, and
tigecycline correlated with increased treatment success. Adverse side effects are common due to long-term, combination
antibiotic therapy.
Ototoxicity, gastrointestinal distress, and myelosuppression are the most severe.