Efficacy of Fluoroquinolone as a Substitute for Ethambutol or Rifampin in the Treatment of Mycobacterium Avium Complex Pulmonary Disease According to the Radiologic Type = Efficacy of Fluoroquinolone as a Substitute for Ethambutol or Rifampin in the Treatment of Mycobacterium Avium Complex Pulmonary Disease According to the Radiologic Type

다국어 초록 (Multilingual Abstract)

Objective
During the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD), ethambutol or rifampin is often discontinued due to adverse events. In this study we investigated the treatment outcomes when fluoroquinolone is substituted for ethambutol or rifampin in MAC-PD treatment according to radiologic type.
Methods
Between 2006 and 2019, 225 patients who initiated guideline-based therapy (GBT) and whose treatment duration was ≥1 year were enrolled at a tertiary referral centre in South Korea, including 178 patients with cavitary disease (fibrocavitary and cavitary nodular bronchiectatic types) and 47 patients with noncavitary nodular bronchiectatic (NC-NB) type. We compared microbiologic cure at 1 year between the patients maintaining GBT and those who replaced ethambutol or rifampin with fluoroquinolone (moxifloxacin or levofloxacin).
Results
The overall microbiologic cure rate of the 178 patients with cavitary disease was 71.3%. Among these, the microbiologic cure rate of the 16 patients who substituted fluoroquinolone for ethambutol was lower than that of the 156 patients who maintained GBT (37.5% vs. 74.4%, respectively; P = 0.007), which was also statistically significant in the multivariate analysis. The outcomes of the six patients in which fluoroquinolone was selected as an alternative to rifampin were similar to that of those receiving GBT. The microbiologic cure rate of the 47 patients with NC-NB was 83.0%; the treatment outcomes were similar whether the patients maintained GBT or replaced ethambutol or rifampin with fluoroquinolone.
Conclusions
In cavitary MAC-PD, substituting fluoroquinolone for ethambutol resulted in inferior patient outcomes. In other cases, treatment outcomes seemed to be similar.