Clinical usefulness of combination chemotherapy for pulmonary Mycobacterium avium complex disease

Abstract

BACKGROUND: This study compared the clinical usefulness of combination chemotherapy including various doses of clarithromycin (CAM) for pulmonary Mycobacterium avium complex (MAC) disease. METHODS: The subjects were divided into three groups receiving combination chemotherapy at various dose levels of CAM. The analysis of microbiological effects was based on the sputum conversion rate and sputum relapsing rate and that of clinical effects was performed by clinical symptoms and radiological findings for patients with pulmonary MAC disease. RESULTS: There were no significant differences among the three groups with regard to patient characteristics. The sputum conversion rate significantly increased with the dose of CAM (CAM 400mg: 43%, CAM 600mg: 69%, CAM 800mg: 88%). The sputum relapsing rate did not significantly differ among the three groups (CAM 400mg: 47%, CAM 600mg: 35%, CAM 800mg: 33%). Along with the sputum conversion rate, the rate of clinical improvement was significantly increased with the dose of CAM (CAM 400mg: 27%, CAM 600mg: 40%, CAM 800mg: 54%). Adverse reactions, such as gastrointestinal symptoms, were most frequently recognized in the group receiving CAM 800mg (38%) compared to those in the other two groups (CAM 400mg: 23% and CAM 600mg: 25%). CONCLUSIONS: Although both the sputum conversion rate and clinical improvement significantly increased with the dose of CAM, the rate of adverse reactions, such as gastrointestinal symptoms, also increased. It is important to continue close monitoring of patients with pulmonary MAC disease treated with a regimen that includes CAM 800mg.