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Macrolide/Azalide therapy for nodular/bronchiectatic mycobacterium avium complex lung disease
Richard J Wallace1, Barbara A Brown-Elliott2, Steven McNulty3
1Department of Medicine, University of Texas Health Science Center at Tyler, Tyler, TX; Department of Microbiology, University of Texas Health Science Center at Tyler, Tyler, TX; Department of Pathology, University of Texas Health Science Center at Tyler, Tyler, TX.
Chest
|January 25, 2014
Summary
Macrolide therapy for Mycobacterium avium complex lung disease is effective, with intermittent dosing better tolerated than daily. Recurrences are common but usually due to reinfection, not resistance.
Area of Science:
- Pulmonology
- Infectious Diseases
- Microbiology
Background:
- Current treatment guidelines for Mycobacterium avium complex (MAC) lung disease lack large-scale validation.
- This study retrospectively reviews macrolide/azalide regimen efficacy for nodular/bronchiectatic (NB) MAC lung disease.
Purpose of the Study:
- To evaluate the efficacy of current treatment guidelines for MAC lung disease.
- To assess macrolide/azalide-containing regimens in patients with nodular/bronchiectatic MAC lung disease.
- To analyze microbiologic responses and macrolide resistance during and after therapy.
Main Methods:
- Retrospective single-center review of 180 patients treated with macrolide/azalide multidrug therapy.
- Evaluation of microbiologic responses, including sputum conversion and recurrence.
- Macrolide susceptibility testing and genotyping of MAC isolates at various time points.
Main Results:
- 86% of patients achieved sputum conversion to culture negative.
- No difference in response between clarithromycin and azithromycin.
- Intermittent therapy showed significantly better tolerance and fewer modifications than daily therapy (1% vs 80%).
- 14% experienced microbiologic recurrence during therapy, predominantly due to reinfection (73%).
- 48% experienced recurrence after therapy completion, mostly reinfection (75%).
- No macrolide resistance developed during treatment.
Conclusions:
- Macrolide/azalide-based therapies align with current guidelines and yield favorable outcomes for NB MAC lung disease.
- Intermittent therapy is effective, well-tolerated, and preferable to daily dosing.
- Microbiologic recurrences are frequent post-therapy, primarily resulting from reinfection rather than true relapse or resistance development.
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