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Antibiotic Treatment of Mycobacterium abscessus Lung Disease

A Retrospective Analysis of 65 Patients

¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, and ² Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; ³ Department of Microbiology, Seoul National University College of Medicine, Seoul, Republic of Korea; and ⁴ Korean Institute of Tuberculosis, Seoul, Republic of Korea

Correspondence and requests for reprints should be addressed to Won-Jung Koh, M.D., Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul, Republic of Korea. E-mail: wjkoh{at}skku.edu

Rationale: The optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease is not well established.

Objectives: To assess the efficacy of a standardized combination antibiotic therapy for the treatment of M. abscessus lung disease.

Methods: Sixty-five patients (11 males, 55 females, median age 55 yr) with M. abscessus lung disease were treated with clarithromycin, ciprofloxacin, and doxycycline, together with an initial regimen of amikacin and cefoxitin for the first 4 weeks of hospitalization.

Measurements and Main Results: Treatment response rates were 83% for symptoms and 74% for high-resolution computed tomography. Sputum conversion and maintenance of negative sputum cultures for more than 12 months was achieved in 38 (58%) patients. These rates were significantly lower in patients whose isolates were resistant to clarithromycin (17%, 2/12) compared with those whose isolates were susceptible or intermediate to clarithromycin (64%, 21/33; P = 0.007). Neutropenia and thrombocytopenia associated with cefoxitin developed in 33 (51%) and 4 (6%) patients, respectively. Drug-induced hepatotoxicity occurred in 10 (15%) patients. Because of these adverse reactions, cefoxitin was discontinued in 39 (60%) patients after treatment for a median of 22 days.

Conclusions: Standardized combination antibiotic therapy was moderately effective in treating M. abscessus lung disease. However, frequent adverse reactions and the potential for long-duration hospitalization are important problems that remain to be solved.

Key Words: atypical mycobacteria • lung diseases • Mycobacterium abscessus • treatment outcome

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease is not well established. What This Study Adds to the Field Standardized combination antibiotic regimen, which is largely based on clarithromycin use, together with an initial 4-week administration of cefoxitin and amikacin, is moderately effective in treating M. abscessus lung disease. However, frequent adverse reactions and the potential need for prolonged hospitalization are important issues that remain to be resolved.