Published ahead of print on March 2, 2006, doi:10.1164/rccm.200509-1531OC
© 2006 American Thoracic Society doi: 10.1164/rccm.200509-1531OC
Factors Related to Response to Intermittent Treatment of Mycobacterium avium Complex Lung DiseaseDivision of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego; Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, California; Department of Medicine, University of Texas Health Center, Tyler, Texas; Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Medicine, New York University Medical Center/Bellevue Hospital, New York City, New York; and Division of Mycobacterial and Respiratory Infections, National Jewish Medical and Research Center, Denver, Colorado Correspondence and requests for reprints should be addressed to Antonino Catanzaro, M.D., Professor of Medicine, University of California, San Diego, 200 West Arbor Drive 8374, San Diego, CA 92103-8374. E-mail: acatanzaro{at}ucsd.edu Rationale: Mycobacterium avium complex pulmonary disease (MAC-PD) is associated with substantial morbidity, and standard daily multidrug therapy is difficult to tolerate. Objectives: To characterize response to a three-times-weekly (TIW) regimen of clarithromycin, ethambutol, and rifampin.
Methods: A 1-yr prospective noncomparative trial of TIW treatment was conducted during 2000–2003 in 17 U.S. cities. Participants were 91 HIV-negative adults, diagnosed with moderate to severe MAC-PD, who originally participated in a trial of an inhaled IFN- Results: Treatment response rates (and median response times) were 44% (2 mo or longer) for culture, 60% (5.5–11.5 mo) for HRCT, and 53% (8.5 mo) for symptoms. Having noncavitary, compared with cavitary, disease increased culture response by 4.0 times (95% confidence interval [CI], 1.7–9.2) and HRCT response by 4.9 times (95% CI, 1.9–13.0). Culture response was 1.5 times (95% CI, 1.1–2.2) higher for older subjects and 2.2 times (95% CI, 1.0–4.7) higher for previously untreated subjects. Being smear-negative increased culture response by 2.3 times (95% CI, 1.1–5.2) but decreased HRCT response by 4.4 times (95% CI, 1.7–11.5). Increasing ethambutol use by 5 mo increased culture response by 1.5 times (95% CI, 1.0–2.1) but decreased symptom response. Not having chronic obstructive pulmonary disease, bronchiectasis, or poor lung function increased symptom response by 1.9 to 3.9 times. Conclusions: TIW therapy was less effective for MAC-PD patients with cavitary disease and a history of chronic obstructive pulmonary disease, bronchiectasis, or previous treatment for MAC-PD. Further research is needed to study the long-term outcomes of TIW treatment.
Key Words: clarithromycin • ethambutol • Mycobacterium avium complex • rifampin • risk factors This article has been cited by other articles:
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treatment. Improvement in sputum culture, high-resolution computed tomography (HRCT), and symptoms were assessed. 
