Tuberc Respir Dis > Volume 57(3); 2004 > Article
Tuberculosis and Respiratory Diseases 2004;57(3):234-241.
DOI:    Published online September 1, 2004.
Treatment of Mycobacterium avium Complex (MAC) Pulmonary Disease.
Won Jung Koh, O Jung Kwon, Eun Hae Kang, Gee Young Suh, Man Pyo Chung, Hojoong Kim, Myung Jin Chung, Tae Sung Kim, Kyung Soo Lee, Nam Yong Lee, Young Kil Park, Gill Han Bai
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Medicine,Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
3Department of Medicine, Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
4Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Seoul, Korea.
There has been a gradual increase in the number of newly diagnosed cases of Mycobacterium avium complex (MAC) pulmonary disease. However, the optimal therapeutic regimen for the disease has not yet established and there is no report about the treatment outcome of MAC pulmonary disease in Korea. This study examined the effect of clarithromycin-based regimen in patients with pulmonary MAC disease without a HIV infection. MATERIALS AND METHODS: Fifty-six patients with pulmonary MAC disease were diagnosed according to the American Thoracic Society criteria from January 2000 to December 2003 at this hospital. Of these patients, 15 were treated with clarithromycin, rifampin, and ethambutol for more than 6 months, together with streptomycin initially (first 6 months) in 8 patients. RESULTS: Six months after the treatment, the sputum cultures converted from positive to negative in 8 patients (53%) and the radiological findings improved in 10 (67%). At 12 months 4 patients (44%) achieved sputum negative conversion and 6 patients out of 9 patients (67%) who were treated for more than 12 months showed radiological improvement. Overall, the sputum findings converted to negative in nine patients (60%) who underwent medical treatment. A pulmonary resection was successfully performed in one patient. Only one patient discontinued the treatment due to side effects such as gastrointestinal intolerance and optic neuritis. CONCLUSION: A combined regimen containing clarithromycin is relatively safe and tolerable even in the elderly outpatients. However, the results of this combined chemotherapy were unsatisfactory and new companion drugs for MAC pulmonary disease are needed. A resection may be considered for localized disease.
Key Words: Atypical mycobacteria, Mycobacterium avium complex, Lung diseases, Treatment, Korea

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