Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Microbiol Spectr. 2023 Jun 15;11(3):e0474122. doi: 10.1128/spectrum.04741-22. Epub 2023 Apr 6.
The comparative outcomes of specific aminoglycosides in cavitary type (fibrocavitary or cavitary nodular bronchiectatic type) Mycobacterium avium complex (MAC) pulmonary disease (PD) are unelucidated. We investigated the treatment outcomes with streptomycin or amikacin inclusion in the treatment regimen. From 2006 to 2020, 168 patients with cavitary MAC-PD who received guideline-based therapy (a three-drug oral antibiotic regimen with macrolide, ethambutol, and rifampin with an injectable aminoglycoside) for ≥1 year at a tertiary referral center in South Korea were retrospectively enrolled. We compared the rates of the culture conversion achievement of patients with streptomycin or amikacin use. Of the 168 participants, 127 patients (75.6%) received streptomycin and 41 (24.4%) received amikacin (median [interquartile range] treatment duration of 17.6 [14.2 to 25.2] and 17.0 [14.0 to 19.4] weeks, respectively). The overall culture conversion rate at treatment completion was 75.6% (127/168), and the rates were similar for the streptomycin-treated and amikacin-treated groups (74.8% [95/127] and 78.0% [32/41], respectively; = 0.674). A multivariate analysis revealed that the achievement of culture conversion did not differ significantly with streptomycin or amikacin use (adjusted odds ratio, 1.086; 95% confidence interval, 0.425 to 2.777). The rate of adverse events was similar in the two groups. In conclusion, in cavitary MAC-PD, treatment with streptomycin-containing and amikacin-containing regimens results in similar rates of culture conversion achievement. We found that among the participants with cavitary MAC-PD who received guideline-based treatment for ≥1 year, the selection of either streptomycin or amikacin in the treatment regimen led to similar rates of culture conversion at treatment completion. In addition, the adverse reaction development rate did not differ significantly for streptomycin and amikacin. These findings suggest that either streptomycin or amikacin can be selected for the treatment of MAC-PD, according to the physician's or patient's preference, such as the route of administration.
空洞型（纤维空洞或空洞性结节性支气管扩张型）鸟分枝杆菌复合体（MAC）肺病（PD）患者使用特定氨基糖苷类药物的治疗结果尚不清楚。我们研究了在治疗方案中包含链霉素或阿米卡星的治疗结果。2006 年至 2020 年，在韩国的一家三级转诊中心，168 例接受空洞型 MAC-PD 指南治疗（口服三联抗生素方案，包括大环内酯类、乙胺丁醇和利福平，加用注射用氨基糖苷类药物）≥1 年的患者被回顾性纳入研究。我们比较了使用链霉素或阿米卡星的患者培养转换率的差异。在 168 名参与者中，127 名（75.6%）接受了链霉素治疗，41 名（24.4%）接受了阿米卡星治疗（中位（四分位间距）治疗时间分别为 17.6（14.2 至 25.2）和 17.0（14.0 至 19.4）周）。治疗结束时的总体培养转化率为 75.6%（127/168），链霉素治疗组和阿米卡星治疗组的转化率相似（分别为 74.8%[95/127]和 78.0%[32/41]；=0.674）。多变量分析显示，培养转换的达成与链霉素或阿米卡星的使用无显著差异（调整比值比，1.086；95%置信区间，0.425 至 2.777）。两组的不良反应发生率相似。结论：在空洞型 MAC-PD 中，含链霉素和阿米卡星方案治疗的培养转换率相似。我们发现，在接受≥1 年基于指南的治疗的空洞型 MAC-PD 患者中，治疗方案中选择链霉素或阿米卡星可导致治疗结束时的培养转化率相似。此外，链霉素和阿米卡星的不良反应发生率无显著差异。这些发现表明，根据医生或患者的偏好，如给药途径，可以选择链霉素或阿米卡星治疗 MAC-PD。
