Treatment of Mycobacterium avium Complex Pulmonary Disease
The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the...
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| Format: | Article |
| Language: | English |
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The Korean Academy of Tuberculosis and Respiratory Diseases
2019-01-01
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| Series: | Tuberculosis and Respiratory Diseases |
| Subjects: | |
| Online Access: | https://www.e-trd.org/search.php?where=aview&id=10.4046/trd.2018.0060&code=0003TRD&vmode=FULL |
| _version_ | 1819102958382481408 |
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| author | Yong-Soo Kwon, M.D. Won-Jung Koh, M.D. Charles L. Daley, M.D. |
| author_facet | Yong-Soo Kwon, M.D. Won-Jung Koh, M.D. Charles L. Daley, M.D. |
| author_sort | Yong-Soo Kwon, M.D. |
| collection | DOAJ |
| description | The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease. |
| first_indexed | 2024-12-22T01:42:50Z |
| format | Article |
| id | doaj.art-4d1bde822a344aebbefae3616d2271d4 |
| institution | Directory Open Access Journal |
| issn | 1738-3536 2005-6184 |
| language | English |
| last_indexed | 2024-12-22T01:42:50Z |
| publishDate | 2019-01-01 |
| publisher | The Korean Academy of Tuberculosis and Respiratory Diseases |
| record_format | Article |
| series | Tuberculosis and Respiratory Diseases |
| spelling | doaj.art-4d1bde822a344aebbefae3616d2271d42022-12-21T18:43:10ZengThe Korean Academy of Tuberculosis and Respiratory DiseasesTuberculosis and Respiratory Diseases1738-35362005-61842019-01-018211526Treatment of Mycobacterium avium Complex Pulmonary DiseaseYong-Soo Kwon, M.D.0https://orcid.org/0000-0001-5121-4488 Won-Jung Koh, M.D.1https://orcid.org/0000-0002-4756-3527 Charles L. Daley, M.D.2https://orcid.org/0000-0003-3324-926XDepartment of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA.The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.https://www.e-trd.org/search.php?where=aview&id=10.4046/trd.2018.0060&code=0003TRD&vmode=FULLnontuberculous mycobacteriamycobacterium avium complexmycobacterium aviummycobacterium intracellularetreatment |
| spellingShingle | Yong-Soo Kwon, M.D. Won-Jung Koh, M.D. Charles L. Daley, M.D. Treatment of Mycobacterium avium Complex Pulmonary Disease Tuberculosis and Respiratory Diseases nontuberculous mycobacteria mycobacterium avium complex mycobacterium avium mycobacterium intracellulare treatment |
| title | Treatment of Mycobacterium avium Complex Pulmonary Disease |
| title_full | Treatment of Mycobacterium avium Complex Pulmonary Disease |
| title_fullStr | Treatment of Mycobacterium avium Complex Pulmonary Disease |
| title_full_unstemmed | Treatment of Mycobacterium avium Complex Pulmonary Disease |
| title_short | Treatment of Mycobacterium avium Complex Pulmonary Disease |
| title_sort | treatment of mycobacterium avium complex pulmonary disease |
| topic | nontuberculous mycobacteria mycobacterium avium complex mycobacterium avium mycobacterium intracellulare treatment |
| url | https://www.e-trd.org/search.php?where=aview&id=10.4046/trd.2018.0060&code=0003TRD&vmode=FULL |
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