CHEST Guidelines-Outcomes-of-Inhaled-Amikacin-Containing-Multidrug-

Outcomes-of-Inhaled-Amikacin-Containing-Multidrug-

Pdf Summary

The study analyzed the outcomes of inhaled amikacin-containing multidrug regimens in treating Mycobacterium abscessus pulmonary disease (M abscessus-PD) and Mycobacterium abscessus subspecies massiliense-PD (M massiliense-PD) among 82 treatment-naive patients. Conducted between March 2015 and June 2018, the research aimed to address the challenges posed by the high antibiotic resistance exhibited by these pathogens.<br /><br />Patients were prescribed an initial phase of intravenous (IV) amikacin, imipenem (or cefoxitin), and oral azithromycin, with oral clofazimine added for M abscessus or for M massiliense with cavitary lesions. The continuation phase involved changing amikacin to an inhalational form.<br /><br />Results showcased a cure rate of 65% after 12 months of treatment, with significant differences between the two subspecies: a high cure rate of 91% for M massiliense-PD and only 31% for M abscessus-PD. Symptomatic improvements were noted in 88% of patients, while radiological improvements were noted in 78%, with M massiliense-PD patients experiencing greater improvements compared to M abscessus-PD patients.<br /><br />The study highlights the need for more effective treatment options for M abscessus-PD, given its lower response rate compared to M massiliense-PD. Despite moderate effectiveness for M abscessus-PD, inhaled amikacin with or without clofazimine was tolerable, though discontinuation due to adverse effects ranged from 11% to 16%.<br /><br />The researchers acknowledged several study limitations, including geographic constraints and variability in treatment regimens among patients. They also urged further research for improved, more targeted therapeutic regimens to effectively combat M abscessus-PD, emphasizing the need for novel approaches to treat this drug-resistant pathogen.

Keywords

inhaled amikacin

Mycobacterium abscessus

pulmonary disease

antibiotic resistance

treatment-naive patients

multidrug regimens

M massiliense-PD

cure rate

symptomatic improvements

drug-resistant pathogen