Abstract
We prospectively investigated the relationship between the clinical efficacy of treatment of pulmonary Mycobacterium avium complex (MAC) disease and drug-sensitivity testing of MAC isolates for antituberculous drugs, new quinolone antibiotics, and clarithromycin (CAM). Fifty-two patients who satisfied the diagnostic criteria of the American Thoracic Society (ATS) and who received treatment between April 1998 and December 2005, using combined therapy of rifampicin (RFP), ethambutol (EB), streptomycin (SM), and CAM, were enrolled in this study. The causative microorganisms isolated were Mycobacterium avium in 30 patients and M. intracellulare in 22 patients. Although separation of the two strains showed drug sensitivity testing to have slightly better minimal inhibitory concentrations (MIC) for M. intracellulare than for M. avium, there were no significant differences in the sputum eradication rate or clinical improvement between the two strains. The MICs of various antibiotics for the isolated MAC strains were as follows: RFP, 0.125–8 µg/ml; CAM, 0.25–16 µg/ml; SM, 2–128≦ µg/ml; EB, 128≦ µg/ml; levofloxacin (LVFX), 1–32 µg/ml; sparfloxacin (SPFX), 0.5–16 µg/ml; and gatifloxacin (GFLX), 0.25–8 µg/ml. The isolated MAC strains showed the same excellent drug sensitivity test results for RFP, new quinolones, and CAM, but they showed resistant drug-sensitivity results for EB and SM. Regarding the relationship between clinical efficacy and the MICs of RFP, EB, CAM, and SM, there was a good relationship only for CAM. Although the ATS has not yet recommended routine drug susceptibility testing of CAM, we believe that drug susceptibility testing of CAM should be performed before the initial treatment is undertaken for pulmonary MAC disease.
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References
M Sakatani (1994) ArticleTitleNontuberculous mycobacteriosis (NTM) in Japan–epidemiologic and clinical study Kekkaku 69 119–24 Occurrence Handle8126988 Occurrence Handle1:STN:280:ByuC2s3ptFU%3D
CR Horsburgh UG Mason LB Heifets K Southwick J Labreque MD Iseman (1987) ArticleTitleResponse to therapy of pulmonary Mycobacterium avium-intracellulare infection correlates with results on in vitro susceptibility testing Am Rev Respir Dis 135 418–21 Occurrence Handle3813205 Occurrence Handle1:CAS:528:DyaL2sXhtlWitLY%3D
RJ Wallace BA Brown DE Griffith WM Girard DT Murphy GO Onyi et al. (1994) ArticleTitleInitial clarithromycin monotherapy for Mycobacterium avium-intracellulare complex lung disease Am J Resp Crit Care Med 149 1335–41 Occurrence Handle8173775
RJ Wallace SuffixJr BA Brown DE Griffith WM Girard DT Murphy (1996) ArticleTitleClarithromycin regimens for pulmonary Mycobacterium avium complex: the first 50 patients Am J Resp Crit Care Med 153 1766–72 Occurrence Handle8665032
InstitutionalAuthorNameAmerican Thoracic Society (1997) ArticleTitleDiagnosis and treatment of disease caused by nontuberculous mycobacteria Am J Respir Crit Care Med 156 S1–S25
InstitutionalAuthorNameJapanese Society for Tuberculosis (1998) ArticleTitleTreatment of nontuberculous mycobacteria Kekkaku 73 588–605
E Tanaka T Kimoto K Tsuyuguchi I Watanabe H Matsumoto A Niimi et al. (1999) ArticleTitleEffect of clarithromycin regimen for Mycobacterium avium complex pulmonary disease Am J Respir Crit Care Med 160 866–72 Occurrence Handle10471610 Occurrence Handle1:STN:280:DyaK1Mvgtlahug%3D%3D
BA Brown RJ Wallace SuffixJr GO Onyi (1992) ArticleTitleActivities of clarithromycin against eight slowly growing species of nontuberculous mycobacteria, determined by using a broth microdilution MIC system Antimicrob Agents Chemother 36 1987–90 Occurrence Handle1416891 Occurrence Handle1:CAS:528:DyaK38Xmt12qtLc%3D
RJ Wallace SuffixJr DR Nash LC Steele V Steingrube (1986) ArticleTitleSusceptibility testing of slowly growing mycobacteria by a microdilution MIC method with 7H9 broth J Clin Microbiol 24 976–81 Occurrence Handle3097069 Occurrence Handle1:CAS:528:DyaL2sXhsFKgtw%3D%3D
L Heifets N Mor J Vanderkolk (1993) ArticleTitleMycobacterium avium strains resistant to clarithromycin and azithromycin Antimicrob Agents Chemother 37 2364–70 Occurrence Handle8031351 Occurrence Handle1:CAS:528:DyaK2cXkvF2nsQ%3D%3D
WW Daniel (1991) Biostatistics. A foundation for analysis in the health sciences EditionNumber5th ed John Wiley & Sons Toronto
Y Kobashi T Matsushima (2003) ArticleTitleThe effect of combined therapy according to the guidelines for the treatment of Mycobacterium avium complex disease Intern Med 42 670–5 Occurrence Handle12924489 Occurrence Handle1:CAS:528:DC%2BD3sXotFCrurg%3D
H Tomioka C Sano K Sato T Shimizu (2002) ArticleTitleAntimicrobial activities of clarithromycin, gatifloxacin and sitafloxacin, in combination with various antimycobacterial drugs against extracellular and intramacrophage Mycobacterium avium complex Int J Antimicrob Agents 19 139–45 Occurrence Handle11850167 Occurrence Handle1:CAS:528:DC%2BD38Xht1ajsLc%3D Occurrence Handle10.1016/S0924-8579(01)00473-3
JC Rodriguez L Cebrian M Lopez M Ruiz G Royo (2005) ArticleTitleUsefulness of various antibiotics against Mycobacterium avium-intracellulare, measured by their mutant prevention concentration Int J Antimicrob Agents 25 221–5 Occurrence Handle15737516 Occurrence Handle1:CAS:528:DC%2BD2MXhvVShtrk%3D Occurrence Handle10.1016/j.ijantimicag.2004.09.018
GL Woods BA Williams-Bouyer RJ Wallace SuffixJr BA Brown-Elliott FG Witebsky PS Conville et al. (2003) ArticleTitleMultisite reproducibility of results obtained by two broth dilution methods for susceptibility testing of Mycobacterium avium complex J Clin Micro 41 627–31 Occurrence Handle1:CAS:528:DC%2BD3sXhslGit7w%3D Occurrence Handle10.1128/JCM.41.2.627-631.2003
T Horiguchi R Kondo J Miyazaki M Shiga M Sugiyama M Handa et al. (2004) ArticleTitleAntibacterial activity and clinical efficacy of sparfloxacin in Mycobacterium avium-intracellulare complex infection J Intern Med Res 32 530–539 Occurrence Handle1:CAS:528:DC%2BD2cXos1CjtLY%3D
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Kobashi, Y., Yoshida, K., Miyashita, N. et al. Relationship between clinical efficacy of treatment of pulmonary Mycobacterium avium complex disease and drug-sensitivity testing of Mycobacterium avium complex isolates. J Infect Chemother 12, 195–202 (2006). https://doi.org/10.1007/s10156-006-0457-8
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DOI: https://doi.org/10.1007/s10156-006-0457-8