Antibiotic treatment of Mycobacterium abscessus lung disease: a retrospective analysis of 65 patients.
BACKGROUND
The optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease is not well established.


OBJECTIVE
To assess the efficacy of a standardized combination antibiotic therapy for the treatment of M. abscessus lung disease.


METHODS
Sixty-five patients (11 males, 55 females, median age 55 yr) with M. abscessus lung disease were treated with clarithromycin, ciprofloxacin, and doxycycline, together with an initial regimen of amikacin and cefoxitin for the first 4 weeks of hospitalization.


RESULTS
Treatment response rates were 83% for symptoms and 74% for high-resolution computed tomography. Sputum conversion and maintenance of negative sputum cultures for more than 12 months was achieved in 38 (58%) patients. These rates were significantly lower in patients whose isolates were resistant to clarithromycin (17%, 2/12) compared with those whose isolates were susceptible or intermediate to clarithromycin (64%, 21/33; P = 0.007). Neutropenia and thrombocytopenia associated with cefoxitin developed in 33 (51%) and 4 (6%) patients, respectively. Drug-induced hepatotoxicity occurred in 10 (15%) patients. Because of these adverse reactions, cefoxitin was discontinued in 39 (60%) patients after treatment for a median of 22 days.


CONCLUSIONS
Standardized combination antibiotic therapy was moderately effective in treating M. abscessus lung disease. However, frequent adverse reactions and the potential for long-duration hospitalization are important problems that remain to be solved.
Jeon
Kyeongman
K
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Kwon
O Jung
OJ
Lee
Nam Yong
NY
Kim
Bum-Joon
BJ
Kook
Yoon-Hoh
YH
Lee
Seung-Heon
SH
Park
Young Kil
YK
Kim
Chang Ki
CK
Koh
Won-Jung
WJ
D000328:Adult; D000583:Amikacin / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002440:Cefoxitin / Q000009:adverse effects / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D002939:Ciprofloxacin / Q000009:adverse effects / Q000627:therapeutic use; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000382:microbiology; D008171:Lung Diseases / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy* / Q000382:microbiology; D009503:Neutropenia / Q000139:chemically induced; D009170:Nontuberculous Mycobacteria / Q000187:drug effects / Q000302:isolation & purification; D012189:Retrospective Studies; D013183:Sputum / Q000187:drug effects / Q000382:microbiology; D013921:Thrombocytopenia / Q000139:chemically induced; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D002440:Cefoxitin; D000583:Amikacin; D017291:Clarithromycin; D004318:Doxycycline