Outcomes in patients with Mycobacterium abscessus pulmonary disease treated with long-term injectable drugs

SummaryBackgroundThe ATS (American Thoracic Society) has recommended periodic administration of multidrug therapy, including a macrolide and one or more parenteral agents or a combination of parenteral agents, over 2–4 months, for treatment of Mycobacterium abscessus pulmonary disease. However, there is little hard evidence supporting these guidelines, and treatment outcomes have not yet been reported.MethodsWe retrospectively evaluated 41 patients with M. abscessus pulmonary disease treated in accordance with ATS guidelines. These patients were treated empirically with multidrug regimens, including a macrolide and one (amikacin) or more (amikacin and cefoxitin or imipenem) parenteral agents, over several months. Treatment outcomes were defined as treatment success, failure, or default.ResultsSeventeen (41.5%) patients were prescribed a macrolide and one parenteral agent, and 24 (58.5%) were prescribed a macrolide and two parenteral agents. The median duration of parenteral and total antibiotic treatment were 230 days (range, 60–601 days) and 511 days (range, 164–1249 days), respectively. The treatment success, failure, and default rates were 80.5% (33/41), 12.2% (5/41), and 7.3% (3/41), respectively. Four patients relapsed over 445 days (range, 0–1443 days) of follow-up. There were no significant differences in treatment success and relapse rates between the groups receiving one and two parenteral agents. Adverse reactions developed in 18 of 41 patients (43.9%).ConclusionsCombination antibiotic therapy, including long-term (minimum 2–4 months) parenteral drugs, as recommended by the ATS, resulted in successful treatment outcomes in 80.5% of patients with M. abscessus lung disease in Korea.