Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease

Byeong Ho Jeong, Kyeongman Jeon, Hye Yun Park, Su Young Kim, Kyung Soo Lee, Hee Jae Huh, Chang Seok Ki, Nam Yong Lee, Sung Jae Shin, Charles L. Daley, Won Jung Koh

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Rationale: 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. Objectives: 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. Measurements and Main 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). Inaddition, 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).

Original languageEnglish
Pages (from-to)96-103
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume191
Issue number1
DOIs
Publication statusPublished - 2015 Jan 1

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Mycobacterium avium Complex
Lung Diseases
Anti-Bacterial Agents
Group Psychotherapy
Ethambutol
Therapeutics
Rifampin
Sputum
Confidence Intervals
Azithromycin
Clarithromycin
Macrolides
Cohort Studies
Retrospective Studies
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Jeong, Byeong Ho ; Jeon, Kyeongman ; Park, Hye Yun ; Kim, Su Young ; Lee, Kyung Soo ; Huh, Hee Jae ; Ki, Chang Seok ; Lee, Nam Yong ; Shin, Sung Jae ; Daley, Charles L. ; Koh, Won Jung. / Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease. In: American Journal of Respiratory and Critical Care Medicine. 2015 ; Vol. 191, No. 1. pp. 96-103.
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abstract = "Rationale: 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. Objectives: 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. Measurements and Main 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). Inaddition, 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).",
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Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease. / Jeong, Byeong Ho; Jeon, Kyeongman; Park, Hye Yun; Kim, Su Young; Lee, Kyung Soo; Huh, Hee Jae; Ki, Chang Seok; Lee, Nam Yong; Shin, Sung Jae; Daley, Charles L.; Koh, Won Jung.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 191, No. 1, 01.01.2015, p. 96-103.

Research output: Contribution to journalArticle

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T1 - Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease

AU - Jeong, Byeong Ho

AU - Jeon, Kyeongman

AU - Park, Hye Yun

AU - Kim, Su Young

AU - Lee, Kyung Soo

AU - Huh, Hee Jae

AU - Ki, Chang Seok

AU - Lee, Nam Yong

AU - Shin, Sung Jae

AU - Daley, Charles L.

AU - Koh, Won Jung

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N2 - Rationale: 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. Objectives: 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. Measurements and Main 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). Inaddition, 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).

AB - Rationale: 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. Objectives: 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. Measurements and Main 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). Inaddition, 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).

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