Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan.
Department of Infectious Diseases, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan.
Respir Investig. 2021 Mar;59(2):212-217. doi: 10.1016/j.resinv.2020.09.010. Epub 2021 Jan 9.
Antibiotic therapy, including clarithromycin (CLR), has been widely used for the management of Mycobacterium avium complex (MAC) lung disease in clinical settings. When patients develop adverse events (AEs) during CLR-based treatment, the treatment regimen is modified or chemotherapy itself is discontinued. The need for alternative macrolide treatment strategies is emphasized due to the high rate of AEs possibly caused by CLR. Thus, the current study aimed to examine the efficacy and safety of azithromycin (AZM) in patients with MAC lung disease whose treatment was switched from CLR to AZM.
We performed a retrospective study of patients with MAC lung disease. The inclusion criteria were as follows: (1) patients who experienced AEs during treatment with antibiotics, including CLR, between December 2012 and November 2017, and (2) those who had antimicrobial therapy that was switched from CLR to AZM. The efficacy and safety of AZM during the clinical course of the disease after switching the regimen from CLR to AZM were investigated.
Antibiotic therapy was switched in 31 patients who presented with AEs including drug-induced fever, rash, dysgeusia, liver dysfunction, and neutropenia during treatment with CLR-containing regimens. After switching to AZM, the median duration of treatment was 1286 (364-4615) days. During follow-up, 13 patients had a negative conversion of sputum culture.
AZM may be safe and effective for patients with MAC lung disease who have difficulty tolerating CLR. In patients who experienced AEs possibly caused by CLR, switching from CLR to AZM might be an appropriate strategy.
在临床环境中，抗生素治疗（包括克拉霉素（CLR））已被广泛用于治疗鸟分枝杆菌复合群（MAC）肺病。当患者在基于 CLR 的治疗过程中出现不良反应（AE）时，会调整治疗方案或停止化疗。由于 CLR 可能导致 AE 发生率高，因此需要替代大环内酯类治疗策略。因此，本研究旨在检查将 CLR 治疗转换为阿奇霉素（AZM）治疗的 MAC 肺病患者的疗效和安全性。
我们对 MAC 肺病患者进行了回顾性研究。纳入标准如下：（1）在 2012 年 12 月至 2017 年 11 月期间接受包括 CLR 在内的抗生素治疗期间出现 AE 的患者，以及（2）那些接受从 CLR 转换为 AZM 的抗菌治疗的患者。在从 CLR 转换为 AZM 后的疾病临床过程中，研究了 AZM 的疗效和安全性。
在 31 名因 CLR 治疗期间出现药物性发热、皮疹、味觉障碍、肝功能障碍和中性粒细胞减少症等 AE 而转换抗生素治疗的患者中，抗生素治疗被转换。转换为 AZM 后，治疗的中位持续时间为 1286（364-4615）天。在随访期间，13 名患者的痰培养转为阴性。
AZM 可能对难以耐受 CLR 的 MAC 肺病患者安全有效。对于因 CLR 引起的 AE 患者，从 CLR 转换为 AZM 可能是一种合适的策略。
