Chest
Original ResearchRespiratory InfectionsTherapeutic Effects of Various Initial Combinations of Chemotherapy Including Clarithromycin Against Mycobacterium avium Complex Pulmonary Disease
Section snippets
Patients and Chemotherapy
We retrospectively evaluated 34 adult patients with noncavitary nodular and bronchiectatic MAC pulmonary disease that had been diagnosed according to 1997 American Thoracic Society diagnostic criteria13 who had been treated at National Minami Yokohama Hospital (Kanagawa, Japan) from 1999 to 2004. All were treatment naive. On arriving at our hospital, the patients had at least one of the following symptoms or complaints: chronic cough; sputum production; hemoptysis; fatigue; and weight loss of >
Results
Among the 10 patients starting regimen A, 1 dropped out because of irregular attendance at the outpatient clinic and a sputum sampling deficit. One patient starting regimen B interrupted chemotherapy because of a drug fever. Two patients receiving regimen C could not complete the treatment because of appetite loss and subjective visual disturbance, respectively. Finally 9, 12, and 13 patients who had completed regimens A, B, and C, respectively, were eligible for retrospective on-treatment
Discussion
The present study demonstrated that higher dose CAM regimens were associated with better culture conversion in MAC-associated bronchiectatic and nodular lung diseases. However, subsequent intensification of early-phase chemotherapy coupled with CAM did not appear to produce an additive effect in this type of MAC pulmonary disease as far as early-phase culture conversion and posttreatment reversion of MAC are concerned.
Although the effect of the CAM dosage on the effectiveness of chemotherapy
Acknowledgments
Author contributions: Drs. Hasegawa, Nishimura, Ohtani, Takeshita, and Fukunaga made substantial contributions to the acquisition, analysis, and interpretation of data. Drs. Hasegawa and Nishimura made substantial contributions to the drafting of the manuscript. Drs. Tasaka and Urano engaged in the radiologic evaluation of HRCT scans. Dr. Ishizaka contributed to the design of the study. Drs. Ishii and Miyairi made substantial contributions to the acquisition of data at outpatient clinic. All
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2022, Journal of Infection and ChemotherapyCitation Excerpt :Therefore, the rate of treatment success in this study was less than that in the pooled analysis, but was comparative with those in 3 studies in Japan [11,29,30]. This agreement is probably because no patients was treated with 1000 mg/day CAM and only 8.6% of patients received streptomycin in this study, similar to the 3 studies in Japan [11,29,30]. There are some limitations in this study.
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2018, ChestCitation Excerpt :Of these, three studies were double-blind controlled studies: Kobashi et al,38 Milanés-Virelles et al,45 and Olivier et al.61 The treatment duration of patients with MAC-PD varied greatly, from 3 months, for example, in the study of Leventhal et al,44 up to at least 24 months in the studies of Kobashi and Matsushima,39 Murray et al,47 and Jenkins et al.33 In nine studies, treatment duration was reported to be 6 months22,26-28,45 or less23,44,57,61; in 16 studies overall (or at least for a separately notified proportion of patients), treatment duration was at least 12 months.25,29-31,33,34,37-40,46,47,50,52,54,55 Six hundred eleven patients with prior NTM treatment of the total of 2,376 patients with MAC (25.7%) were identified in 24 of the 42 included studies (57.1%).
The clinical efficacy of a clarithromycin-based regimen for Mycobacterium avium complex disease: A nationwide post-marketing study
2017, Journal of Infection and ChemotherapyCitation Excerpt :In addition, the negative conversion rate reached approximately 80% at 12 months of treatment and was maintained thereafter at a nearly steady state; therefore, the response evaluation at 12–18 months of treatment might guide subsequent treatment decisions. The following factors were considered to be involved in bacilli negative conversion: age, treatment history, M. intracellulare infection, positive sputum smears, extended opacities on radiographs, fibrocavitary-type disease, resistance to CAM, low-dose CAM, short-term treatment with EB for 5 months or less, and treatment continuation for less than 12 months after the initial conversion [16,18,21–24,26–29]. In the present study, no significant difference in the bacilli negative conversion rate was detected in relation to sex, disease type, pathogens, MIC of CAM, or combination of drugs in a CAM-based regimen.
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