Macrolide resistant Mycobacterium avium complex pulmonary disease following clarithromycin and ethambutol combination therapy.

Abstract

RATIONALE:

Whether two-drug therapy (clarithromycin and ethambutol) for Mycobacterium avium complex (MAC) pulmonary disease contributes to the development of macrolide-resistant MAC is unclear.

OBJECTIVE:

To compare the incidence of macrolide-resistant MAC between patients treated with two-drug therapy (clarithromycin and ethambutol) and the standard three-drug therapy (clarithromycin, ethambutol, and rifampicin) for MAC pulmonary disease.

METHODS:

We retrospectively reviewed 147 patients with treatment-naive MAC pulmonary disease who had received two-drug therapy (n = 47) or three-drug therapy (n = 100) between 1997 and 2016 at National Hospital Organization, Tenryu Hospital, Hamamatsu, Japan. The risk of development of macrolide-resistant MAC was evaluated by calculating the cumulative incidence rate using Gray's test.

RESULTS:

The median follow-up period was 74.5 months. During the follow-up period, one of the 47 patients (2.1%) in the two-drug group developed macrolide-resistant MAC, compared to 12 of the 100 patients (12.0%) in the three-drug group. The cumulative incidence rate of macrolide-resistant MAC was lower in the two-drug group than in the three-drug group (0.0023; 95% confidence interval, 0.002 to 0.107 versus 0.200; 95% confidence interval, 0.100 to 0.324, p = 0.0593).

CONCLUSIONS:

These results suggest that two-drug treatment with clarithromycin and ethambutol for MAC pulmonary disease does not lead to a higher incidence of resistance acquisition to clarithromycin than the standard three-drug treatment.

• Authors: Yasuhiro Ito, Seiichi Miwa, Masahiro Shirai, Miho Kanai, Kaoru Fujita, Hisano Ohba, Eriko Iwaizumi, Tomoko Oshima, Suguru Kojima, Takafumi Suda, Hiroshi Hayakawa
• Journal: Respiratory medicine (Respir Med) Vol. 169 Pg. 106025 (08 2020) ISSN: 1532-3064 [Electronic] England
• PMID: 32442113 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Macrolides
• Ethambutol
• Clarithromycin
• Rifampin

Topics

• Aged
• Anti-Bacterial Agents (pharmacology)
• Clarithromycin (adverse effects, therapeutic use)
• Drug Resistance, Bacterial
• Drug Therapy, Combination
• Ethambutol (adverse effects, therapeutic use)
• Female
• Humans
• Incidence
• Japan (epidemiology)
• Macrolides (pharmacology)
• Male
• Middle Aged
• Mycobacterium avium Complex (drug effects)
• Mycobacterium avium-intracellulare Infection
• Negative Results
• Pneumonia, Bacterial (drug therapy, epidemiology, microbiology)
• Rifampin (adverse effects, therapeutic use)