Tolerability outcomes of ATS/IDSA guideline-recommended multi-drug antibiotic treatment for Mycobacterium avium complex pulmonary disease in U.S. Medicare beneficiaries with bronchiectasis

Chest. 2023 Dec 10:S0012-3692(23)05846-4. doi: 10.1016/j.chest.2023.12.006. Online ahead of print.ABSTRACTBACKGROUND: Nontuberculous mycobacteria are environmental organisms that are increasingly causing chronic and debilitating pulmonary infections, of which Mycobacterium avium complex (MAC) is the most common pathogen. MAC pulmonary disease (MAC-PD) is often difficult to treat, often requiring long-term multi-drug antibiotic therapy.RESEARCH QUESTION: Is there an association between various guideline-based 3-drug therapy (GBT) regimens and (1) therapy-associated adverse events; or (2) regimen change/discontinuation, within 12 months of therapy initiation?STUDY DESIGN AND METHODS: In a retrospective cohort study, we examined tolerability outcomes of GBT regimens for MAC-PD in 4,626 U.S. Medicare beneficiaries with bronchiectasis, who were prescribed a GBT as initial antibiotic treatment for presumed MAC-PD during 2006 - 2014. Using multivariable Cox proportional hazard regression, we estimated adjusted hazard ratios (aHR) to compare the risk of adverse events and regimen change/discontinuations within 12 months of therapy initiation in various GBT regimens.RESULTS: Our cohort had a mean age of 77.9 years (standard deviation 6.1) at treatment start, were mostly female (77.7%), and non-Hispanic white (87.2%). The risk of regimen change/discontinuation within 12 months of therapy was higher for clarithromycin-based regimens compared to azithromycin-based regimens (aHR 1.12 [95%...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research