Effective treatment for clarithromycin-resistant Mycobacterium avium complex lung disease |
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| Affiliation: | 1. Department of Pharmaceutical Sciences, International University of Medicine and Welfare, Ohtawara, Japan;2. Faculty of Medicine, Shimane University, Izumo, Japan;3. Department of Basic Medical Sciences for Nursing, Department of Primary Education, Yasuda Women''s University, Hiroshima 731-0153, Japan;1. Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku Sakai, Osaka 591-8555, Japan;2. Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku Sakai, Osaka 591-8555, Japan;3. Clinical laboratory, National Hospital Organization Kinki-chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku Sakai, Osaka 591-8555, Japan;4. QIAGEN K.K., 3-13-1 Kachidoki, Chuo-ku, Tokyo 104-0054, Japan;1. Servicio de Dermatología, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, N.L., Mexico;2. Centro de Investigación Biomédica del Noreste, IMSS, Monterrey, N.L., Mexico |
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| Abstract: | Clinical management of macrolide-resistant Mycobacterium avium complex (MR-MAC) lung disease is difficult. To date, there only exist a limited number of reports on the treatment of clarithromycin-resistant MAC (CR-MAC) lung disease. This study aimed to evaluate prognostic factors and identify effective treatments in CR-MAC lung disease. We retrospectively collected clinical data of patients newly diagnosed with CR-MAC lung disease at the Kinki-Chuo Chest Medical Center between August 2010 and June 2018. Altogether, 37 patients with CR-MAC lung disease were enrolled. The median age was 69 years; 30, 22, and 21 patients received clarithromycin, ethambutol, and rifampicin, respectively, on their own or in drug combination. The observed sputum culture conversion rate was 29.7% (11/37 patients). In univariate analysis, ethambutol significantly increased the rate of sputum culture conversion (p = 0.027, odds ratio (OR) 10; 95% confidence interval (CI) 1.11–89.77). Multivariate analysis confirmed that ethambutol increased sputum culture conversion rate (p = 0.026; OR 21.8; 95% CI 1.45–329) while the existence of lung cavities decreased it (p = 0.04; OR 0.088; 95% CI 0.009–0.887). The combined use of ethambutol with other drugs may improve sputum culture conversion rate in CR-MAC lung disease. |
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| Keywords: | Clarithromycin Ethambutol Treatment Drug resistance MAC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," $$" :[{" #name" :" italic" ," _" :" Mycobacterium avium" },{" #name" :" __text__" ," _" :" complex MR-MAC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," $$" :[{" #name" :" __text__" ," _" :" macrolide-resistant " },{" #name" :" italic" ," _" :" Mycobacterium avium" },{" #name" :" __text__" ," _" :" complex CR-MAC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," $$" :[{" #name" :" __text__" ," _" :" clarithromycin-resistant " },{" #name" :" italic" ," _" :" mycobacterium avium" },{" #name" :" __text__" ," _" :" complex NB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" nodular/bronchiectatic FC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" fibrocavitary AFB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" acid-fast-bacillus |
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