Therapeutic effects of various initial combinations of chemotherapy including clarithromycin against Mycobacterium avium complex pulmonary disease.
BACKGROUND
The objective of this study was to find an optimal initial combination chemotherapy that includes clarithromycin (CAM) for treatment-naive patients with Mycobacterium avium complex (MAC) pulmonary disease, as assessed by microbiological conversion using a Mycobacterium growth indicator tube (MGIT).


METHODS
Thirty-four patients with treatment-naive MAC pulmonary disease (determined using 1997 American Thoracic Society criteria) were evaluated retrospectively. They demonstrated a nodular and bronchiectatic pattern without cavity on high-resolution CT (HRCT) scans. The following three regimens were administered: regimen A (n = 9) consisted of CAM (400 mg/d), ethambutol (EB) [750 mg/d], and rifampicin (RFP) [450 mg/d]; regimen B (n = 12) consisted of CAM (800 mg/d), EB (750 mg/d), and RFP (450 mg/d); and regimen C (n = 13) consisted of CAM (800 mg/d), EB (1,000 mg/d), and RFP (600 mg/d) during the first 2 months followed by a reduction of the dosage of EB from 1,000 to 750 mg/d. Gender, age, BMI, and HRCT scan finding scores were not significantly different among the three groups. Chemotherapy was continued for 18 months. Sputum culture was periodically assessed by MGIT.


RESULTS
Culture conversion at 18 months in regimen A (55.6%), which included a daily dosage of 400 mg of CAM (9.5 mg/kg), was significantly inferior to that in regimen B (91.7%), which included daily 800 mg of CAM (17.6 mg/kg; p < 0.05), but regimen B and C (92.3%) showed no between-group difference after > 18 months of chemotherapy.


CONCLUSIONS
The higher dose of CAM allowed for better culture conversion. Daily combination chemotherapy that includes CAM (800 mg) seems appropriate as an initial treatment against treatment-naive patients with nodular and bronchiectatic MAC pulmonary disease.
Hasegawa
Naoki
N
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. Electronic address: hasegawn@sc.itc.keio.ac.jp.
Nishimura
Tomoyasu
T
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Medicine, Sano Kohsei General Hospital, Tochigi, Japan.
Ohtani
Sumire
S
Department of Medicine, National Minami-Yokohama Hospital, Kanagawa, Japan.
Takeshita
Kei
K
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Medicine, Kitasato Institute Hospital, Tokyo, Japan.
Fukunaga
Koichi
K
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Medicine, Saitama Social Insurance Hospital, Saitama, Japan.
Tasaka
Sadatomo
S
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Urano
Tetsuya
T
Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan.
Ishii
Koudou
K
Department of Medicine, National Minami-Yokohama Hospital, Kanagawa, Japan.
Miyairi
Mamoru
M
Department of Medicine, National Minami-Yokohama Hospital, Kanagawa, Japan.
Ishizaka
Akitoshi
A
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001987:Bronchiectasis / Q000000981:diagnostic imaging; D017291:Clarithromycin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004977:Ethambutol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy*; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D004977:Ethambutol; D017291:Clarithromycin; D012293:Rifampin