Related Experiment Video
Updated: May 29, 2025
Author Spotlight: Optimizing CFU Determination for Efficient Assessment of TB Vaccine Efficacy and Antigen Presentation Analysis
Published on: July 28, 2023
Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patients
Kyota Shinfuku1, Hiromichi Hara2, Keitaro Okuda2
1Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho Komae, Tokyo, 201-8601, Japan. shinfuku.112@gmail.com.
Background:
Mycobacterium avium complex pulmonary disease (MAC-PD) is considered to be increasing worldwide. In Japan, the number of elderly MAC-PD patients requiring treatment is also expected to increase due to the aging society. However, reduced organ function in elderly patients makes it often difficult to continue or complete multidrug treatment due to adverse drug reactions (ADRs). Therefore, this study aimed to identify clinical factors associated with treatment tolerability, efficacy, and ADRs in elderly MAC-PD patients.
Methods:
We retrospectively reviewed the medical records of 102 patients with MAC-PD aged ≥ 75 years between January 2014 and March 2023. Forty-six patients were treated with multidrug regimens (treatment group), and 56 were observed without treatment (observation group). The treatment group was divided into the treatment continuation group (n = 28) who were treated without interruption for ≥ 12 months, and the treatment interruption group (n = 18). A comparative study was conducted in each group to examine tolerability, efficacy, and ADRs.
Results:
A two-drug regimen of ethambutol (EB) and macrolides without rifampicin (RFP) was associated with treatment continuation (p = 0.026). The treatment continuation group was superior to the observation group regarding symptoms change, sputum conversion rate, and chest computed tomography scores. The most common ADRs were gastrointestinal disorders, which may be related to RFP. Treatment efficacy of the two-drug regimen was non-inferior, and no cases of macrolide resistance were observed.
Conclusions:
The two-drug regimen of EB and macrolide without RFP may be a tolerable and effective treatment for elderly MAC-PD patients.
Insights
A two-drug regimen of ethambutol and macrolides without rifampicin is a tolerable and effective treatment for elderly patients with Mycobacterium avium complex pulmonary disease (MAC-PD). This approach improves symptoms and sputum conversion while minimizing adverse drug reactions.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Geriatrics
Background:
- Mycobacterium avium complex pulmonary disease (MAC-PD) is increasing globally, with a rising number of elderly patients in Japan requiring treatment.
- Elderly patients often experience reduced organ function, complicating multidrug treatment completion due to adverse drug reactions (ADRs).
- Identifying factors for treatment tolerability, efficacy, and ADRs in elderly MAC-PD patients is crucial.
Purpose of the Study:
- To identify clinical factors associated with treatment tolerability, efficacy, and ADRs in elderly MAC-PD patients (≥75 years).
- To compare the outcomes of multidrug regimens versus observation in elderly MAC-PD patients.
- To evaluate the safety and effectiveness of specific drug combinations.
Main Methods:
- Retrospective review of 102 elderly MAC-PD patients (January 2014 - March 2023).
- Comparison of 46 patients on multidrug regimens (treatment group) versus 56 patients without treatment (observation group).
- Analysis of treatment continuation (≥12 months) versus interruption, examining tolerability, efficacy, and ADRs.
Main Results:
- A two-drug regimen of ethambutol (EB) and macrolides without rifampicin (RFP) was linked to treatment continuation (p=0.026).
- The treatment continuation group showed superior symptom changes, sputum conversion rates, and chest CT scores compared to the observation group.
- Gastrointestinal disorders were the most common ADRs, potentially linked to RFP; the two-drug regimen showed non-inferior efficacy without macrolide resistance.
Conclusions:
- A two-drug regimen of EB and macrolides without RFP appears tolerable and effective for elderly MAC-PD patients.
- This regimen may offer a viable alternative to standard multidrug therapy, improving outcomes and reducing ADRs in this vulnerable population.
- Further research could solidify this regimen's role in managing elderly MAC-PD.
Related Concept Videos
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:21Factors Affecting Drug Response: Overview
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:28Pulmonary Tuberculosis II
Here is a detailed explanation of its pathophysiology:
Transmission: The process begins when a person inhales droplet nuclei containing M. tuberculosis. These are typically released into the air when an individual with pulmonary or...
01:26Pulmonary Tuberculosis IV
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...