Intermittent Therapy for MAC Pulmonary Infections?

Neil M. Ampel, MD

In an observational study involving 217 patients with nodular bronchiectatic disease, outcomes were similar between individuals receiving three-times-weekly therapy and those receiving daily therapy.

Mycobacterium avium complex lung disease (MAC-LD) is increasing in prevalence. One form, nodular bronchiectatic (NB) disease, frequently involves the right middle lobe and lingula and occurs predominantly in nonsmoking, postmenopausal women. Although the American Thoracic Society recommended three-times-weekly (“intermittent”) therapy for noncavitary MAC-LD in 2007, data to support its use in NB disease are limited.

Now, in an observational cohort study involving 217 patients with NB MAC-LD in Seoul, South Korea between 2005 and 2013, researchers have compared daily and intermittent therapy. Patients who began treatment before January 2011 received therapy daily; those who began treatment later received it three times weekly. For the 99 patients on daily therapy, the initial antibiotic regimen often included clarithromycin (87 patients) or streptomycin (60). Ninety-two of the 118 patients on intermittent therapy initially received azithromycin, and none received streptomycin.

After 12 months of treatment, rates of symptomatic and radiographic improvement, sputum culture conversion, and microbiological recurrence, as well as time to sputum conversion, were similar between groups. Modification of the initial antibiotic regimen and discontinuation of ethambutol occurred more frequently in the daily group (for both comparisons, P<0.001).

Citation(s):

Jeong B-H et al. Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease. Am J Respir Crit Care Med 2015 Jan 1; 191:96.

Bag R and Griffith DE.Therapy for Mycobacterium avium complex lung disease. It ain't perfect, but it's progress. Am J Respir Crit Care Med 2015 Jan 1; 191:14.