Abstract
Surveys suggest that clinicians diverge from guidelines when treating Mycobacterium avium complex (MAC) pulmonary disease (PD). To determine prescribing patterns, we conducted a cohort study of adults >66 years of age in Ontario, Canada, with MAC or Mycobacterium xenopi PD during 2001-2013. Using linked laboratory and health administrative databases, we studied the first treatment episode (>60 continuous days of >1 of a macrolide, ethambutol, rifamycin, fluoroquinolone, linezolid, inhaled amikacin, or, for M. xenopi, isoniazid). Treatment was prescribed for 24% MAC and 15% of M. xenopi PD patients. Most commonly prescribed was the recommended combination of macrolide, ethambutol, and rifamycin, for 47% of MAC and 36% of M. xenopi PD patients. Among MAC PD patients, 20% received macrolide monotherapy and 33% received regimens associated with emergent macrolide resistance. Although the most commonly prescribed regimen was guidelines-recommended, many regimens prescribed for MAC PD were associated with emergent macrolide resistance.
Highlights
In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases
A sensitivity analysis limited to patients who survived >2 years after Nontuberculous mycobacteria (NTM) pulmonary disease (PD) diagnosis indicated that treatment was received by 622/2533 (24.6%) of Mycobacterium avium complex (MAC) PD patients and 114/785 (14.5%) of M. xenopi PD patients
Compared with MAC PD patients who did not receive treatment, those who did receive treatment were younger; more likely to be female (59.4 vs. 54.8%); more likely to reside in neighborhoods in the higher income quintile and rural settings; more likely to have bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease; and less likely to have diabetes mellitus, chronic kidney disease, and lung cancer (Table 1)
Summary
In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Physicians should claim only the credit commensurate with the extent of their participation in the activity Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Identify the percentage of older adults with MAC-PD and Mx-PD in Ontario, Canada, who received antimicrobial therapy and factors associated with receipt of treatment, according to a retrospective cohort study
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