title: Macrolide-Resistant Mycobacterium avium Complex Lung Disease: Analysis of 102 Consecutive Cases.
abstract: The management of macrolide-resistant Mycobacterium avium complex (MR-MAC) pulmonary disease is difficult and is thought to be analogous to that of multidrug-resistant tuberculosis (MDR-TB).
  
  
  
  This study aimed to clarify the cause of MR-MAC, to see how its management affected outcome, and to compare its prognosis with that of MDR-TB.
  
  
  
  The medical records of 102 consecutive cases with MR-MAC pulmonary disease at three tertiary hospitals for mycobacteriosis in metropolitan Tokyo and one in Aichi prefecture from 2005 to 2014 were reviewed. The data of 311 consecutive cases with MDR-TB were extracted from the medical data at Fukujuji Hospital.
  
  
  
  Of the 90 patients who met the criteria, 53 (58.9%) received inappropriate first-line treatment, and 28 (31.1%) deviated from the standard treatment because of the adverse effects of ethambutol. The survival rates for MR-MAC disease and MDR-TB were not significantly different (P = 0.6). Multivariate analysis showed that the combination of aminoglycoside and surgery resulted in the best treatment outcome (P = 0.02), although neither of the two factors reached significance by themselves. The continuation of clarithromycin and the addition of fluoroquinolones did not improve the outcome for the treatment of disease caused by MR-MAC.
  
  
  
  Inappropriate prescription patterns and deviations from the standard treatment because of adverse drug reactions appeared to be the main causes of macrolide resistance in this patient series. Drug sensitivity testing should be performed at diagnosis to identify macrolide resistance and patients who may benefit from other therapy.
authors: 1 Respiratory Disease Center, Fukujuji Hospital, and.
authors: Kozo
authors: K
authors: Morimoto
authors: 2 Division of Pulmonary Medicine, School of Medicine, and.
authors: Ho
authors: 0000-0001-6181-4284
authors: H
authors: Namkoong
authors: 2 Division of Pulmonary Medicine, School of Medicine, and.
authors: Naoki
authors: N
authors: Hasegawa
authors: 3 Department of Pulmonary Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan.
authors: Taku
authors: T
authors: Nakagawa
authors: 4 Department of Respiratory Medicine, Division of Infectious Diseases, National Center for Global Health and Medicine, Tokyo, Japan.
authors: Eriko
authors: E
authors: Morino
authors: 1 Respiratory Disease Center, Fukujuji Hospital, and.
authors: Yuji
authors: Y
authors: Shiraishi
authors: 3 Department of Pulmonary Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan.
authors: Kenji
authors: K
authors: Ogawa
authors: 5 Department of Epidemiology and Clinical Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan.|6 Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan; and.
authors: Kiyohiko
authors: K
authors: Izumi
authors: 4 Department of Respiratory Medicine, Division of Infectious Diseases, National Center for Global Health and Medicine, Tokyo, Japan.
authors: Jin
authors: J
authors: Takasaki
authors: 1 Respiratory Disease Center, Fukujuji Hospital, and.
authors: Takashi
authors: T
authors: Yoshiyama
authors: 7 Department of Mycobacteriology, National Institute of Infectious Diseases, Tokyo, Japan.
authors: Yoshihiko
authors: Y
authors: Hoshino
authors: 1 Respiratory Disease Center, Fukujuji Hospital, and.
authors: Shuichi
authors: S
authors: Matsuda
authors: 3 Department of Pulmonary Medicine, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan.
authors: Yuta
authors: Y
authors: Hayashi
authors: 1 Respiratory Disease Center, Fukujuji Hospital, and.
authors: Yuka
authors: Y
authors: Sasaki
authors: 2 Division of Pulmonary Medicine, School of Medicine, and.
authors: Makoto
authors: M
authors: Ishii
authors: 1 Respiratory Disease Center, Fukujuji Hospital, and.
authors: Atsuyuki
authors: A
authors: Kurashima
authors: 8 Keio University Health Center, Keio University, Tokyo, Japan.
authors: Tomoyasu
authors: T
authors: Nishimura
authors: 2 Division of Pulmonary Medicine, School of Medicine, and.
authors: Tomoko
authors: T
authors: Betsuyaku
authors: 1 Respiratory Disease Center, Fukujuji Hospital, and.
authors: Hajime
authors: H
authors: Goto
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use*; D017291:Clarithromycin / Q000009:adverse effects; D004977:Ethambutol / Q000009:adverse effects; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008171:Lung Diseases / Q000188:drug therapy / Q000382:microbiology; D018942:Macrolides / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015269:Mycobacterium avium Complex / Q000187:drug effects; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D004977:Ethambutol; D017291:Clarithromycin
keywords: clarithromycin; multidrug-resistant tuberculosis; prognosis; side effect