ACROLIDE/AZIDE THERAPY FOR NODULAR/BRONCHIECTATIC MYCOBACTERIIUM AVIUM COMPLEX LUNG DISEASE (Wallace et al, Chest 2014; 146(2):276-82).
This was a retrospective analysis of 180 patients with nodular-bronchiectatic MAC pulmonary disease who had completed at least 12 months of treatment with macrolide/azide multidrug therapy (daily or three times weekly). Sputum conversion to culture negative occurred in 86%. There were no differences in response between clarithromycin or azithromycin regimens. Modification of treatment regimens occurred more frequently with daily therapy. Macrolide resistance did not develop during therapy. Recurrences occurred in 48% after completion of therapy, mostly with reinfection rather than relapse.
Summary: Current guidelines for macrolide/azide-based therapies for nodular-bronchiectatic MAC lung disease are effective. Intermittent therapy is better tolerated than daily.
INHALED AMIKACIN FOR TREATMENT OF REFRACTORY PULMONARY NONTUBERCULOUS MYCOBACTERIAL DISEASE (Olivier et al, Ann Am Thorac Soc 2014; 11:30-35)
The efficacy of nebulised amikacin in 20 patients (2 with CF) chronically infected with either MAC or M.abscessus was examined. During amikacin treatment, 25% became persistently culture negative with a further 45% exhibiting a decrease in smear quantity. Symptom scores improved in 45%. However, 35% had to discontinue the drug due to significant toxicity.
Summary: Nebulised amikacin may be beneficial to some patients, however toxicity is common.