Standardized combination antibiotic treatment of Mycobacterium avium complex lung disease.
OBJECTIVE
The optimal treatment regimen for Mycobacterium avium complex (MAC) lung disease has not yet been fully established. We evaluated the efficacy of standardized combination antibiotic therapy and the factors that might affect unfavorable microbiologic responses in patients with MAC pulmonary disease.


METHODS
This retrospective study reviewed data from 96 patients (56 females; median age 59 years) treated with newly diagnosed MAC lung disease between January 2003 and December 2006.


RESULTS
All patients received standardized combination antibiotic therapy, consisting of clarithromycin, rifampicin, and ethambutol. Streptomycin was additionally given in 72 patients (75%) for a median duration of 4.5 months. The overall favorable microbiologic response rate was 79% (76/96); 20 patients (21%) had unfavorable microbiologic responses, including failure to sputum conversion (n = 13), relapse (n = 3), and MAC-related death (n = 4). A positive sputum acid-fast bacillus smear at the start of treatment was an independent predictor of an unfavorable microbiologic response.


CONCLUSIONS
Standardized combination antibiotic therapy consisting of clarithromycin, rifampicin, and ethambutol with or without initial use of streptomycin is effective in treating patients with newly diagnosed MAC lung disease.
Sim
Yun Su
YS
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Park
Hye Yun
HY
Jeon
Kyeongman
K
Suh
Gee Young
GY
Kwon
O Jung
OJ
Koh
Won-Jung
WJ
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000379:methods*; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000188:drug therapy*; D009162:Mycobacterium avium / Q000378:metabolism*; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004977:Ethambutol; D017291:Clarithromycin; D012293:Rifampin; D013307:Streptomycin