TABLE 2.
Combination antimycobacterial chemotherapy and other clinical interventions examined by selected studiesa
| Reference | No. of patients treated | Type of infectionc | erm(41) gene deletion (no. of patients/total no.) | No. of patients with CF, AAT, or CDb | Macrolide(s) used | Aminoglycoside(s) usedd | Other antibiotics used in combination therapy; no. of patients who received surgery | Duration, moe (range) |
|
|---|---|---|---|---|---|---|---|---|---|
| Therapy | Follow-up | ||||||||
| Macrolide-free regimens | |||||||||
| Griffith et al. (21) | 120 | 120 NSS | NA | 9 CF | None | i.v. AMK, daily | FOX, IPM, SXT, ERY, other anti-TB drugs; 7 | NA | 58.8 ± 4.8 |
| Macrolide-containing regimens | |||||||||
| van Ingen et al. (32) | 12 | 9 M. abscessus subsp. abscessus, 2 M. abscessus subsp. massiliense, 1 M. abscessus subsp. bolletii | NA | 4 CF | CLR | i.v. AMK, daily | FOX, IPM, SXT, LVX, and first-line anti-TB drugs; 1 | 13 | NA |
| Jeon et al. (14) | 86 | 86 NSS | NA | NA | CLR | 1/12 i.v. AMK, twice daily | FOX, IPM, CIP, DOX; 14 | 24.4 ± 0.2 | 12 (5–30) |
| Jarand et al. (23) | 107 | 107 M. abscessus subsp. abscessus | NA | 25 CF, 1 AAT | AZM, CLR | 3/12 i.v. AMK | FOX, IPM, LVX, SXT and others, individualized based on DST; 24 | 52 ± 40.6 | 34 ± 21.1 |
| Lyu et al. (26) | 41 | 41 NSS | NA | NA | AZM, CLR | 8/12 i.v. AMK, once daily | FOX, IPM, DOX, quinolones (CIP, MXF); 13 | 17.03 (5.46–41.63) | 14.83 (0–48.1) |
| Koh et al. (15) | 67 | 30 M. abscessus subsp. Abscessus, 37 M. abscessus subsp. massiliense | 0/19 M. abscessus subsp. abscessus, 28/28 M. abscessus subsp. massiliense | NA | CLR | 1/12 i.v., AMK twice daily | FOX, IPM, DOX, CIP; 0 | 23.1 ± 12.9 M. abscessus subsp. abscessus, 21.6 ± 7.7 M. abscessus subsp. massiliense | NA |
| Harada et al. (22) | 64 | 42 M. abscessus subsp. abscessus, 20 M. abscessus subsp. massiliense, 2 M. abscessus subsp. bolletii | NA | NA | AZM, CLR, ERY | i.v. STP, AMK, KAN | FOX, IPM, DOX, quinolones (CIP, MXF); anti-TB drugs; 6 | 33 (3–178) M. abscessus subsp. abscessus, 36 (1–122) M. abscessus subsp. massiliense, 36 (4–68) M. abscessus subsp. bolletii | 25 (1–120) M. abscessus subsp. abscessus, 18 (1–62) M. abscessus subsp. massiliense |
| Tung et al. (31) | 56 | 56 M. abscessus subsp. abscessus | NA | NA | CLR | i.v. AMK | FOX, IPM, MEM, DOX, quinolones (CIP, MXF); anti-TB drugs; 0 | 12 | NA |
| Griffith et al. (7) | 11 | 11 M. abscessus subsp. abscessus | NA | NA | AZM, CLR | i.v. AMK | FOX, IPM | NA | 48.3 ± 28.7 |
| Namkoong et al. (27) | 13 | 13 M. abscessus subsp. abscessus | NA | NA | CLR | i.v. AMK, thrice weekly | Faropenem, sitafloxacin, MIN, IPM; 0 | 21.31 ± 2.10 | 12 |
| Koh et al. (25) | 71 | 71 M. abscessus subsp. massiliense | 16/16 | NA | AZM, CLR | i.v. AMK | 2-wk regimen of FOX, IPM; 3; 4-wk regimen of FOX, IPM, quinolones (CIP, MXF); 2 | 2-wk regimen, 15.2 (12.7–18.1); 4-wk regimen, 23.9 (23.1–24.1) | 2-wk regimen, 14.7 (0.5–29.5); 4-wk regimen, 33.8 (12.3–50.3) |
| Czaja et al. (20) | 47 | 47 M. abscessus subsp. abscessus | NA | 9 CF, 5 AAT | AZM | 9/12 i.v. and inhalation AMK daily | FOX, IPM, quinolones, CFO; 16 | 17.3 ± 6.6 | 24.97 ± 1.40 |
| Koh et al. (24) | 67 | 67 M. abscessus subsp. abscessus | 7/44 | NA | AZM, CLR | i.v. AMK | FOX, IPM, quinolones (CIP, MXF), DOX; 9 | >12 mo | 11.8 (3.6–27) |
| Park et al. (30) | 113 | 56 M. abscessus subsp. abscessus, 54 M. abscessus subsp. massiliense, 3 mixed | 27/56 (M. abscessus subsp. abscessus), 3/54 (M. abscessus subsp. massiliense) | NA | AZM, CLR | i.v. AMK, 3–5 times weekly | FOX, IPM; 5 (3 M. abscessus subsp. abscessus, 2 M. abscessus subsp. massiliense) | 15.25 (7–29) M. abscessus subsp. Abscessus, 21.75 (16–30) M. abscessus subsp. massiliense | 42.13 ± 22.47 |
| Macrolide-containing regimen plus investigational drugs | |||||||||
| Olivier et al. (29) | 15 | 10 M. abscessus subsp. abscessus, 5 M. abscessus subsp. massiliense | 11/15 | 2 CF, 1 CD | CLR | Nebulized AMK | AMK nebulized 250 mg/ml daily; CLR given daily | 60 (6–190) | 19 (1–50) |
| Wallace et al. (33) | 34 | 34 NSS | 22 CF | AZM, CLR | AMK, tobramycin | FOX, IPM, MEM, quinolones (CIP, MXF), EMB, SXT; 3 | 8.5 ± 8.86 | NA | |
| Yang et al. (34) | 42 | 42 M. abscessus subsp. abscessus | 7/42 | NA | AZM | 4/52 i.v. AMK daily | Initial CLO therapy of FOX, IPM; 1; salvage CLO therapy added to existing regimen (quinolones [CIP, MXF], FOX, IPM); 2 | Both treatment groups, 48.0 (24.8–48.0) | 12.0 |
| Olivier et al. (28) | 32 | 32 NSS | NA | 14 CF | AZM, CLR | 3/12 liposomal AMK daily, Tobramycin | 15 patients on intervention regimen of FOX, IPM, MEM, quinolones (CIP, MXF, LVF), DOX, linezolid, CLO, anti-TB drugs; 0; 17 patients on placebo regimen of FOX, IPM, MEM, quinolone (CIP, MXF, LVF), DOX, linezolid, CLO, TGC, anti-TB drugs; 0 | >24 | 12 |
| Choi et al. (19) | 15 | 15 M. abscessus subsp. massiliense (all macrolide resistant) | 14/15 | NA | AZM, CLR | i.v. and inhalation AMK daily | FOX, IPM, quinolone (CIP, MXF), DOX, SXT; 3 surgery | Prior macrolide, 10 (IQR, 4–17) versus 18.7 (IQR, 11.2–39.8) | 38.7 (IQR, 11.4–41.9) |
a
Antibiotic or drug abbreviations: AMK, amikacin; AZM, azithromycin; CIP, ciprofloxacin; CLO, clofazimine; CLR, clarithromycin; DOX, doxycycline; EMB, ethambutol; ERY, erythromycin; FOX, cefoxitin; IPM, imipenem; LVX, levofloxacin; MEM, meropenem; MIN, minocycline; MXF, moxifloxacin; SXT, trimethoprim-sulfamethoxazole; TGC, tigecycline.
b
CF, cystic fibrosis; AAT, abnormal α-1 antitrypsin; CD, ciliary dyskinesia; NA, data not available.
c
NSS, M. abscessus subspecies not specified.
d
i.v., intravenous.
e
IQR, interquartile range.