Document Detail


The effect of combined therapy according to the guidelines for the treatment of Mycobacterium avium complex pulmonary disease.
MedLine Citation:
PMID:  12924489     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate whether the combined therapy according to the guideline proposed by American Thoracic Society (ATS) and Japanese Society for Tuberculosis (JST) is clinically appropriate for Mycobacterium avium complex (MAC) pulmonary disease. PATIENTS: Seventy-one patients in whom MAC pulmonary disease was diagnosed at Kawasaki Medical School and our associated ten hospitals were prospectively studied. RESULTS: Seventy-one patients with Mycobacterium avium complex (MAC) pulmonary disease were 27 males and 44 females with a mean age of 64.4 +/- 10.2 years old. Patients received 400 mg/day or 600 mg/day of clarithromycin plus ethambutol, rifampicin, and initial streptomycin for 12 months. Among 71 patients who received more than 12 months of therapy, 41 patients (57.7%) converted their sputum to negative within six months after the initiation of this regimen, 16 of 41 patients (39.0%) relapsed, and 23 of 71 patients (32.4%) obtained clinical improvement on chest X-ray and/or clinical symptoms. The mortality rate had a comparatively good prognosis with a low incidence of 2.8%. Although the species of pathogen (M. avium or M. intracellulare) did not significantly affect the conversion rate or clinical improvement, the infectious form with or without respiratory underlying disease, the characteristics and extent of lesion on chest X-ray, and the dose of clarithromycin significantly influenced the conversion rate or clinical improvement. There were no problems concerning adverse reactions for this regimen. CONCLUSION: This combined therapy, according to the guideline proposed by ATS and JST, was one of the effective treatments compared to the clinical effect of only antituberculous drugs through this study. However, this combined therapy was unsatisfactory compared to the clinical effect for pulmonary tuberculosis. The development of new companion drugs for MAC pulmonary diseases is needed.
Authors:
Yoshihiro Kobashi; Toshiharu Matsushima
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  Internal medicine (Tokyo, Japan)     Volume:  42     ISSN:  0918-2918     ISO Abbreviation:  Intern. Med.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-19     Completed Date:  2003-12-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9204241     Medline TA:  Intern Med     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  670-5     Citation Subset:  IM    
Affiliation:
Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Antitubercular Agents / therapeutic use*
Clarithromycin / therapeutic use*
Drug Therapy, Combination / therapeutic use*
Ethambutol / therapeutic use*
Female
Humans
Lung Diseases / drug therapy*,  microbiology*
Male
Middle Aged
Mycobacterium avium Complex
Mycobacterium avium-intracellulare Infection / complications,  drug therapy*
Practice Guidelines as Topic
Prospective Studies
Rifampin / therapeutic use*
Streptomycin / therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antitubercular Agents; 13292-46-1/Rifampin; 57-92-1/Streptomycin; 74-55-5/Ethambutol; 81103-11-9/Clarithromycin
Comments/Corrections
Comment In:
Intern Med. 2003 Aug;42(8):627-8   [PMID:  12924480 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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