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Review
. 2024 Mar 11;25(1):123.
doi: 10.1186/s12931-024-02752-y.

Variables associated with antibiotic treatment tolerance in patients with Mycobacterium avium complex pulmonary disease

Meghan Marmor  1 , Husham Sharifi  2 , Susan Jacobs  2 , Kiana Fazeli  2 , Stephen Ruoss  2
Affiliations
Review

Variables associated with antibiotic treatment tolerance in patients with Mycobacterium avium complex pulmonary disease

Meghan Marmor et al. Respir Res. .

Abstract

Background: Treatment of Mycobacterium avium complex pulmonary disease (MAC-PD) involves prolonged courses of multiple antibiotics that are variably tolerated and commonly cause adverse drug reactions (ADR). The purpose of this retrospective, single-center study was to identify demographic and disease-related variables associated with significant ADRs among patients treated with antibiotics against MAC-PD.

Methods: We reviewed all patients treated with antibiotic therapy for MAC-PD at a single center from 2000 to 2021. Patients were included if they met diagnostic criteria for MAC-PD, were prescribed targeted antibiotic therapy for any length of time and had their treatment course documented in their health record. We compared patients who completed antibiotics as originally prescribed (tolerant) with those whose antibiotic treatment course was modified or terminated secondary to an ADR (intolerant).

Results: Over the study period, 235 patients were prescribed antibiotic treatment with their clinical course documented in our center's electronic health record, and 246 treatment courses were analyzed. One hundred forty-three (57%) tolerated therapy versus 108 (43%) experienced ADRs. Among the 108 intolerant courses, 67 (63%) required treatment modification and 49 (46%) required premature treatment termination. Treatment intolerance was associated more frequently with smear positive sputum cultures (34% vs. 20%, p = 0.009), a higher Charlson Comorbidity Index (CCI) (4 vs. 6, p = 0.007), and existing liver disease (7% vs. 1%, p = 0.03). There was no between-group difference in BMI (21 vs. 22), fibrocavitary disease (24 vs. 19%), or macrolide sensitivity (94 vs. 80%). The use of daily therapy was not associated with intolerance (77 vs. 79%). Intolerant patients were more likely to be culture positive after 6 months of treatment (44 vs. 25%).

Conclusions: Patients prescribed antibiotic therapy for MAC-PD are more likely to experience ADRs if they have smear positive sputum cultures at diagnosis, a higher CCI, or existing liver disease. Our study's rate of early treatment cessation due to ADR's was similar to that of other studies (20%) but is the first of its kind to evaluate patient and disease factors associated with ADR's. A systematic approach to classifying and addressing ADRs for patients undergoing treatment for MAC-PD is an area for further investigation.

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Conflict of interest statement

This study was approved by Stanford’s Institutional Review Board. None of the authors have any competing interests to declare. Data and materials are property of Stanford Health Care electronic medical record and are not available for outside review. This study was not funded. Marmor is the primary author and responsible for data collection. Sharifi contributed to data collection and was the primary data analyst. Jacobs contributed to data interpretation and writing of the manuscript. Fazeli contributed to manuscript writing. Ruoss contributed to data interpretation and manuscript writing.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Associations between treatment tolerance and treatment time. Red square is mean, horizontal grey line is median, box is interquartile range. Each dot represents a treatment course for a patient
See this image and copyright information in PMC

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