Intermittent Antibiotic Therapy for Nodular Bronchiectatic Mycobacterium avium Complex Lung Disease
Intermittent Antibiotic Therapy for Nodular Bronchiectatic Mycobacterium avium Complex Lung Disease
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DOI：
10.1164/rccm.201408-1545oc
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发表时间：
2015-01-01
影响因子：
24.7
通讯作者：
Koh, Won-Jung
中科院分区：
文献类型：
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作者：
Jeong, Byeong-Ho;Jeon, Kyeongman;Koh, Won-Jung
基本原理：虽然间歇性每周三次治疗被推荐用于非空洞结节性支气管扩张型鸟分枝杆菌复合体（MAC）肺病的初始治疗，但支持数据有限。目的：评价间歇性治疗与每日治疗结节性支气管扩张型MAC肺病的临床疗效。一项对217例未经治疗的非空洞结节性支气管扩张MAC肺病患者的回顾性队列研究。所有患者接受每日（n = 99）或间歇（n = 118）治疗，包括克拉霉素或阿奇霉素，利福平和乙胺丁醇。测量和主要结果：每日治疗组比间歇治疗组更频繁地修改初始抗生素治疗（46对21%; P < 0.001）;特别是，每日治疗组中停用乙胺丁醇的频率高于间歇治疗组（24对1%; P < 0.001）。然而，两组的症状改善率、影像学改善率和痰培养转化率无差异（每日治疗vs.间歇治疗：分别为75 vs. 82%，P = 0. 181; 68 vs. 73%，P = 0. 402; 76 vs. 67%，P = 0. 154）。此外，调整后的痰培养转化比例与每日治疗相似（71.3%; 95%置信区间，59.1-81.1%）和间歇治疗组（73.69; 95%置信区间，62.9-82.2%; P = 0：785）。这些结果表明，间歇性每周三次治疗与大环内酯类，利福平，乙胺丁醇是一个合理的初始治疗方案，非空洞结节性支气管扩张MAC肺疾病的患者。
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). In addition, 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 (73.69; 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.