Background: The difficulty of treatment for pulmonary Mycobacterium avium complex (MAC) in Japan. Objectives: To investigate the clinical and microbiological effects of treatment according to the guidelines proposed by the American Thoracic Society and the Japanese Society for Tuberculosis and prospective follow-up studies after the completion of treatment of patients with pulmonary MAC disease. Methods: Analysis of the microbiological effects with regard to sputum conversion rate and the sputum relapsing rate and the clinical effects with regard to clinical symptoms and radiological findings for patients with pulmonary MAC disease treated with a regimen consisting of rifampicin, ethambutol, streptomycin, and clarithromycin over 24 months and follow-up over 12 months. Results: Sixty-five patients with pulmonary MAC disease were enrolled in this trial. In 39 patients, negative sputum conversion was observed within 6 months after the initiation of this regimen, 16 relapsed, and 20 experienced clinical worsening within 1 year after the completion of treatment. Although retreatment with the same regimen or a regimen including new quinolones was carried out for these patients, we could not achieve negative sputum conversion and/or clinical improvement. Conclusions: We believe that the dose of clarithromycin for pulmonary MAC disease may be increased and recommend surgery for patients with a localized lesion at early-stage MAC disease to prevent a high rate of relapse.

1.
Sakatani M: Nontuberculous mycobacteriosis (NTM) in Japan – epidemiologic and clinical study. Kekkaku 1994;69:119–124.
2.
American Thoracic Society: Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med 1997;156(suppl):S1–S25.
3.
Japanese Society for Tuberculosis: Treatment of nontuberculous mycobacteriosis. Kekkaku 1998;73:599–605.
4.
Brown BA, Wallace RJ Jr, Onyi GO: Activities of clarithromycin against eight slowly growing species of nontuberculous mycobacteria, determined by using a broth microdilution MIC system. Antimicrob Agents Chemother 1992;36:1987–1990.
5.
Wallace RJ Jr, Nash DR, Steele LC, Steingrube V: Susceptibility testing of slowly growing mycobacteria by a microdilution MIC method with 7H9 broth. J Clin Microbiol 1986;24:976–981.
6.
Heifets L, Mor N, Vanderkolk J: Mycobacterium avium strains resistant to clarithromycin and azithromycin. Antimicrob Agents Chemother 1993;37:2364–2370.
7.
Daniel WW: Biostatics. A Foundation for Analysis in the Health Sciences, ed 5. Toronto, Wiley, 1991.
8.
Wallace RJ Jr, Brown BA, Griffith DE, Girard WM, Murphy DT: Clarithromycin regimen for pulmonary Mycobacterium avium complex: the first 50 patients. Am J Respir Crit Care Med 1996;153:1766–1772.
9.
Tanaka E, Kimoto T, Tsuyuguchi K, et al: Effect of clarithromycin regimen for Mycobacterium avium complex pulmonary disease. Am J Respir Crit Care Med 1999;160:866–872.
10.
Wallace RJ Jr, Brown BA, Griffith DE: Drug intolerance to high-dose clarithromycin among elderly patients. Diagn Microbiol Infect Dis 1993;16:215–221.
11.
Kunin CM: Antimicrobial activity of rifabutin. Clin Infect Dis 1996;22:S3–S13.
12.
Wallace RJ Jr, Brown BA, Griffith W, et al: Reduced serum levels of clarithromycin in patients treated with multidrug regimens including rifampin or rifabutin for Mycobacterium avium M. intracellulare infection. J Infect Dis 1995;171:747–750.
13.
Shefran SD, Deschenes J, Miller M, et al: Uveitis and pseudojaundice during a regimen of clarithromycin, rifabutin, and ethambutol. N Engl J Med 1994;330:438–439.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.