Efficacy and safety of kanamycin addition in patients with drug-refractorymycobacterium aviumcomplex lung disease

Abstract

Introduction: The 2007 ATS/IDSA statement for Mycobacterium avium complex (MAC) lung disease suggested that aminoglycoside antibiotics should be considered in addition to clarithromycin (CAM), rifampicin, and ethambutol for extensive fibrocavitary disease or patients deteriorated with prior medications. Aims: To evaluate efficacy and safety of kanamycin (KM) added to the patients with drug-refractory MAC infection. Methods: We selected patients with MAC pulmonary disease treated with kanamycin more than 3 months after deterioration with a standard therapy from 2010 to 2013. Patients with comorbid aspergillosis or simultaneous administration of quinolones were excluded. Medical records were retrospectively reviewed to evaluate symptomatic and radiographic improvement, sputum culture conversion and adverse effects. Results: The patients included were 11 males and 19 females with the median age of 66 years. The mean duration from the initiation of chemotherapy to KM addition was 5.83 years. CAM resistant MAC was isolated in 9 cases. Symptomatic improvement was indicated in 56.5% while radiographic abnormalities were improved in 15/29 (51.7%), stable in 11/29 (37.9%), and deteriorated in 3/29 (10.3%) 3 months later. Among 13 smear positive and 17 culture positive patients prior to KM addition, semi-quantitative count of sputum smear was decreased in 9 (69.2%) and sputum culture turned negative in 5 (29.4%). Side effects were rash (2 cases), renal dysfunction (2), hearing disorder (1), and eosinophilia (1). Conclusions: Addition of kanamycin is effective even after failure of initial chemotherapy and should be considered as a treatment option for drug-refractory MAC lung disease.