Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease.
BACKGROUND
Although intermittent, three-times-weekly therapy is recommended for the initial treatment of noncavitary nodular bronchiectatic Mycobacterium avium complex (MAC) lung disease, supporting data are limited.


OBJECTIVE
To evaluate the clinical efficacy of intermittent therapy compared with daily therapy for nodular bronchiectatic MAC lung disease.


METHODS
A retrospective cohort study of 217 patients with treatment-naive noncavitary nodular bronchiectatic MAC lung disease. All patients received either daily (n = 99) or intermittent therapy (n = 118) that included clarithromycin or azithromycin, rifampin, and ethambutol.


RESULTS
Modification of the initial antibiotic therapy occurred more frequently in the daily therapy group than in the intermittent therapy group (46 vs. 21%; P < 0.001); in particular, ethambutol was more frequently discontinued in the daily therapy group than in the intermittent therapy group (24 vs. 1%; P ≤ 0.001). However, the rates of symptomatic improvement, radiographic improvement, and sputum culture conversion were not different between the two groups (daily therapy vs. intermittent therapy: 75 vs. 82%, P = 0.181; 68 vs. 73%, P = 0.402; 76 vs. 67%, P = 0.154, respectively). In addition, the adjusted proportion of sputum culture conversion was similar between the daily therapy (71.3%; 95% confidence interval, 59.1-81.1%) and the intermittent therapy groups (73.6%; 95% confidence interval, 62.9-82.2%; P = 0.785).


CONCLUSIONS
These results suggest that intermittent three-times-weekly therapy with a macrolide, rifampin, and ethambutol is a reasonable initial treatment regimen for patients with noncavitary nodular bronchiectatic MAC lung disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00970801).
1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
Byeong-Ho
BH
Jeong
Kyeongman
K
Jeon
Hye Yun
HY
Park
Su-Young
SY
Kim
Kyung Soo
KS
Lee
Hee Jae
HJ
Huh
Chang-Seok
CS
Ki
Nam Yong
NY
Lee
Sung Jae
SJ
Shin
Charles L
CL
Daley
Won-Jung
WJ
Koh
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017963:Azithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D018942:Macrolides / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000187:drug effects*; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy*; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D056910:Republic of Korea; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D018942:Macrolides; D017963:Azithromycin; D004977:Ethambutol; D017291:Clarithromycin; D012293:Rifampin
Mycobacterium avium complex; ethambutol; macrolides; nontuberculous mycobacteria; treatment