CHEST Guidelines-The-Association-of-Long-term-Macrolide-Therapy-and

The-Association-of-Long-term-Macrolide-Therapy-and

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This study investigated the association between long-term macrolide therapy and nontuberculous mycobacterial (NTM) culture positivity in patients with bronchiectasis. Bronchiectasis often leads to increased pulmonary infections, prompting guidelines to recommend chronic macrolide therapy for those experiencing frequent exacerbations. The concern arises with such therapy potentially leading to macrolide-resistant Mycobacterium avium complex (MAC) infection. The study used data from the United States Bronchiectasis and NTM Research Registry (BRR), focusing on subjects who had a negative NTM culture at the baseline visit and at least one follow-up visit.<br /><br />Participants were divided into macrolide and non-macrolide therapy groups. At the 1-year follow-up, 3.3% of macrolide patients versus 13.8% of non-macrolide patients presented with at least one positive NTM culture, with statistical analyses revealing significantly lower odds of NTM positivity in the macrolide group. These findings suggest that macrolide therapy may not only be low in prompting NTM positivity but could potentially have a protective effect against NTM infection. Despite the limited sample size and follow-up duration, the results hint at the potential for using chronic macrolide therapy prophylactically in patients at high risk for NTM infection.<br /><br />Overall, this study indicates low NTM positivity rates among those undergoing macrolide therapy for bronchiectasis, suggesting a protective role and opening up the possibility for prophylactic use, pending further large-scale studies. However, before initiating such treatment, clinicians should rule out unrecognized NTM infections to avoid the development of resistant strains. Further research is needed to confirm the safety and efficacy of macrolide monotherapy in preventing NTM disease among bronchiectasis patients.

Keywords

macrolide therapy

nontuberculous mycobacterial

bronchiectasis

Mycobacterium avium complex

NTM culture positivity

pulmonary infections

chronic macrolide therapy

macrolide-resistant infection

prophylactic use

Bronchiectasis and NTM Research Registry