Tuberc Respir Dis.  2004 Sep;57(3):234-241. 10.4046/trd.2004.57.3.234.

Treatment of Mycobacterium avium Complex (MAC) Pulmonary Disease

• Koh WJ
• Kwon OJ
• Kang EH
• Suh GY
• Chung MP
• Kim H
• Chung MJ
• Kim TS
• Lee KS
• Lee NY
• Park YK
• Bai GH

• KMID: 1656512
• DOI: http://doi.org/10.4046/trd.2004.57.3.234

Abstract

BACKGROUND: There has been a gradual increase in the number of newly diagnosed cases of Mycobacterium avium complex (MAC) pulmonary disease. However, the optimal therapeutic regimen for the disease has not yet established and there is no report about the treatment outcome of MAC pulmonary disease in Korea. This study examined the effect of clarithromycin-based regimen in patients with pulmonary MAC disease without a HIV infection.
MATERIALS AND METHODS
Fifty-six patients with pulmonary MAC disease were diagnosed according to the American Thoracic Society criteria from January 2000 to December 2003 at this hospital. Of these patients, 15 were treated with clarithromycin, rifampin, and ethambutol for more than 6 months, together with streptomycin initially (first 6 months) in 8 patients.
RESULTS
Six months after the treatment, the sputum cultures converted from positive to negative in 8 patients (53%) and the radiological findings improved in 10 (67%). At 12 months 4 patients (44%) achieved sputum negative conversion and 6 patients out of 9 patients (67%) who were treated for more than 12 months showed radiological improvement. Overall, the sputum findings converted to negative in nine patients (60%) who underwent medical treatment. A pulmonary resection was successfully performed in one patient. Only one patient discontinued the treatment due to side effects such as gastrointestinal intolerance and optic neuritis.
CONCLUSION
A combined regimen containing clarithromycin is relatively safe and tolerable even in the elderly outpatients. However, the results of this combined chemotherapy were unsatisfactory and new companion drugs for MAC pulmonary disease are needed. A resection may be considered for localized disease.

Keyword

Atypical mycobacteria; Mycobacterium avium complex; Lung diseases; Treatment; Korea

MeSH Terms

Aged
Clarithromycin
Drug Therapy
Ethambutol
Friends
HIV Infections
Humans
Korea
Lung Diseases*
Mycobacterium avium Complex*
Mycobacterium avium*
Mycobacterium*
Nontuberculous Mycobacteria
Optic Neuritis
Outpatients
Rifampin
Sputum
Streptomycin
Treatment Outcome
Clarithromycin
Ethambutol
Rifampin
Streptomycin