title: Treatment of refractory Mycobacterium avium complex lung disease with a moxifloxacin-containing regimen.
abstract: Moxifloxacin (MXF) has in vitro and in vivo activity against Mycobacterium avium complex (MAC) in experimental models. However, no data are available concerning its treatment effect in patients with MAC lung disease. The aim of this study was to evaluate the clinical efficacy of an MXF-containing regimen for the treatment of refractory MAC lung disease. Patients with MAC lung disease who were diagnosed between January 2002 and December 2011 were identified from our hospital database. We identified 41 patients who received MXF for ≥ 4 weeks for the treatment of refractory MAC lung disease. A total of 41 patients were treated with an MXF-containing regimen because of a persistent positive culture after at least 6 months of clarithromycin-based standardized antibiotic therapy. The median duration of antibiotic therapy before MXF administration was 410 days (interquartile range [IQR], 324 to 683 days). All patients had culture-positive sputum when MXF treatment was initiated. The median duration of MXF administration was 332 days (IQR, 146 to 547 days). The overall treatment success rate was 29% (12/41), and the median time to sputum conversion was 91 days (IQR, 45 to 190 days). A positive sputum acid-fast-bacillus smear at the start of treatment with MXF-containing regimens was an independent predictor of an unfavorable microbiological response. Our results indicate that MXF may improve treatment outcomes in about one-third of patients with persistently culture-positive MAC lung disease who fail to respond to clarithromycin-based standardized antibiotic treatment. Prospective studies are required to assess the clinical efficacy of MXF treatment for refractory MAC lung disease.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
authors.forename: Goohyeon
authors.initials: G
authors.lastname: Hong
authors.forename: Su-Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Byeong-Ho
authors.initials: BH
authors.lastname: Jeong
authors.forename: Hye Yun
authors.initials: HY
authors.lastname: Park
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
authors.forename: Seung-Heon
authors.initials: SH
authors.lastname: Lee
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Kim
authors.forename: Sung Jae
authors.initials: SJ
authors.lastname: Shin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D000077266:Moxifloxacin; D015269:Mycobacterium avium Complex / Q000187:drug effects* / Q000254:growth & development; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy* / Q000382:microbiology; D011804:Quinolines / Q000627:therapeutic use*; D012293:Rifampin / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D004977:Ethambutol; D017291:Clarithromycin; D000077266:Moxifloxacin; D012293:Rifampin