한빛사 논문
Abstract
Byeong-Ho Jeong1, Kyeongman Jeon1, Hye Yun Park1, Su-Young Kim1, Kyung Soo Lee2, Hee Jae Huh3, Chang-Seok Ki3, Nam Yong Lee3, Sung Jae Shin4 Charles L. Daley5, Won-Jung Koh1,*
1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, 2 Department of Radiology and 3 Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, 4 Department of Microbiology, Yonsei University College of Medicine, Seoul, Korea, 5 Division of Mycobacterial and Respiratory Infections, Department of Medicine, National Jewish Health, Denver, Colorado
Jeong BH and Jeon K contributed equally to this work.
* Correspondence and requests for reprints should be addressed to Won-Jung Koh, M.D., Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 135-710, Korea.
Abstract
Rationale: Although intermittent, three-times-weekly therapy is recommended for the initial treatment of non-cavitary 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 non-cavitary 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 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). In addition, the adjusted proportion of sputum culture conversion was similar between the daily therapy (71.3%, 95% confidence interval [CI] 59.1-81.1%) and the intermittent therapy groups (73.6%, 95% CI 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 non-cavitary nodular bronchiectatic MAC lung disease. Clinical trial registration can be found at www. clinicaltrials.gov, ID NCT00970801.
KEYWORDS: Nontuberculous mycobacteria, Mycobacterium avium complex, macrolides, ethambutol, treatment
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