title: Use of mefloquine in multidrug-resistant Mycobacterium avium complex pulmonary disease in an HIV-negative patient.
abstract: BACKGROUND
  Mycobacterium avium complex (MAC) is a leading cause of pulmonary disease (PD), even in those with intact immunity, representing about 30% of the cases of pleuropulmonary mycobacterial infection. Based on previous studies, macrolides are the only agents used in the treatment of MAC disease for which there is a correlation between in vitro susceptibility and in vivo (clinical) response. However, resistance develops rapidly if single-agent treatment is used. Data regarding treatment of macrolide-resistant MAC (MRMAC) and multidrug-resistant MAC (MDRMAC) are sparse.
  
  
  METHODS
  A 50-year-old, HIV-negative white man, weighing 53.6 kg, with severe chronic obstructive pulmonary disease and bronchiectasis was initially on treatment for MAC-PD and MRMAC. The patient was followed between 1999 and 2006. His treatment history revealed that in addition to the multiple drugs administered during the course of his illness, thalidomide, interferon-γ, and mefloquine were also administered. The patient died ~7 years later due to respiratory failure and overwhelming infection
  
  
  CONCLUSIONS
  This case report describes the use of mefloquine as adjunct treatment in an HIV-negative patient with MDRMAC-PD and discusses the associated outcomes of drug resistance.
authors.affiliation: Division of Pulmonary, Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Juan
authors.initials: J
authors.lastname: Ramirez
authors.affiliation: Division of Pulmonary, Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Carol
authors.initials: C
authors.lastname: Mason
authors.affiliation: Division of Pulmonary, Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Juzar
authors.initials: J
authors.lastname: Ali
keywords: Mycobacterium avium complex; Mycobacterium avium complex pulmonary disease; acid-fast bacillus; bronchiectasis; macrolide-resistant Mycobacterium avium complex; mefloquine; multidrug-resistant; mycobacteria; nontuberculous mycobacteria