Antibiotic therapy success rate in pulmonary Mycobacterium avium complex: a systematic review and meta-analysis

Mohammad Javad Nasiri, Golnaz Ebrahimi, Samaneh Arefzadeh, Samin Zamani, Zahra Nikpor, Mehdi Mirsaeidi

Research output: Contribution to journalArticle

Abstract

Objectives: The incidence of Mycobacterium avium complex (MAC) pulmonary disease is increasing worldwide. We conducted a systematic review and meta-analysis to determine the treatment success rate of antibiotic therapy in MAC pulmonary disease and evaluate the effectiveness of aminoglycoside-containing regimens. Methods: We searched literature between 1 January 1980 to 19 June 2019. Studies with diagnosis criteria based on the current guidelines that reported treatment outcomes were included. We defined treatment success as the achievement of culture conversion and completion of the planned treatment without relapse while on treatment. Results: We retrieved 45 studies including 3862 patients. The estimated pooled treatment success rate was 68.1% [95% confidence interval (CI) 64.7–71.4%]. Based on the Cochrane tool, the included studies had a low risk of bias. Forty-two studies reported macrolide-containing regimens, while 6 studies included aminoglycoside-containing regimens. Macrolide-containing regimens led to better treatment success rates comparing to non-macrolide-containing regimens; 69% vs 58.5%, respectively. Treatment duration of 12 months or more showed better results. Conclusion: Poor treatment success rate of MAC pulmonary disease calls for more randomized clinical trials designed based on consensus definitions of the disease diagnosis and treatment. New drugs with a better adherence rate need to be developed. Systematic Review Registration: PROSPERO (pending registration ID: 151674).

Original languageEnglish (US)
Pages (from-to)263-273
Number of pages11
JournalExpert Review of Anti-Infective Therapy
Volume18
Issue number3
DOIs
StatePublished - Mar 3 2020

Keywords

  • Meta-analysis
  • mycobacterium
  • nontuberculous mycobacteria
  • pulmonary disease
  • treatment outcome

ASJC Scopus subject areas

  • Microbiology
  • Microbiology (medical)
  • Virology
  • Infectious Diseases

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