Table 3.
Antibiotic regimens prescribed to patients treated for Mycobacterium avium complex by physician specialty
| Regimens Prescribed to Patients with MAC by Treating Physician Specialty |
|||
|---|---|---|---|
| |
Infectious Disease |
Pulmonology |
Family/General Practice and Internal Medicine |
| Treatment Regimen | n (%) | n (%) | n (%) |
| Total number of regimens prescribed (mean # regimens per patient) | 194 (1.5) | 237 (2.0) | 88 (1.5) |
| Treatment regimens meeting ATS/IDSA guidelines | 20 (10) | 42 (18) | 8 (9) |
| Macrolide, ethambutol, and rifamycin | 19 (10) | 41 (17) | 8 (9) |
| Macrolide, ethambutol, rifamycin, and parenteral aminoglycoside | 1 (0.5) | 1 (0.4) | — |
| Treatment regimens not meeting ATS/IDSA guidelines for MAC* | 174 (90) | 195 (82) | 80 (91) |
| Treatment regimens that may increase macrolide resistance | 45 (23) | 95 (40) | 20 (23) |
| Macrolide monotherapy | 23 (12) | 51 (22) | 10 (11) |
| Macrolide plus fluoroquinolone | 4 (2) | 3 (1) | 1 (1) |
| Macrolide plus rifampin | 18 (9) | 41 (17) | 9 (10) |
| Treatment regiments that are of unknown clinical significance | 3 (2) | — | — |
| Macrolide plus inhaled amikacin | 1 (0.5) | — | — |
| Macrolide plus linezolid | 2 (1) | — | — |
| Treatment regimens that do not include macrolides | 126 (65) | 100 (42) | 60 (68) |
| Ethambutol plus rifamycin | 35 (18) | 53 (22) | 17 (19) |
| Fluoroquinolone based regimen | 44 (23) | 25 (11) | 13 (15) |
| Parenteral aminoglycoside based regimen | 1 (0.5) | 1 (0.4) | 10 (11) |
| Linezolid based regimen | 1 (0.5) | — | — |
| Any nonmacrolide antibiotic monotherapy regimen | 45 (23) | 21 (9) | 20 (23) |
Definition of abbreviations: ATS = American Thoracic Society; IDSA = Infectious Diseases Society of America; MAC = Mycobacterium avium complex.
Patients with treatment regimens overseen by more than one physician specialty type or by physician specialties other than those listed were excluded from this table (n = 44). Macrolides include clarithromycin and azithromycin; rifamycins include rifampin and rifabutin; parenteral aminoglycosides include streptomycin and amikacin; and fluorquinolones include ofloxacin, ciprofloxacin, levofloxacin, and moxifloxacin.
There are currently no drug regimens of proven efficacy for the treatment of M. abscessus lung disease according to the 2007 ATS/IDSA guidelines (6).