Antibiotic treatment for nontuberculous mycobacteria lung infection in people with cystic fibrosis

Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 12/2012; 12(12):CD010004. DOI: 10.1002/14651858.CD010004.pub2
Source: PubMed


Nontuberculous mycobacteria are bacteria that are in the same family as tuberculosis and are commonly found in the soil and water. These bacteria can be found in the lungs of people with cystic fibrosis and can cause their lung function to worsen. Although there are guidelines on which antibiotics to use to treat lung infection due to these bacteria, these recommendations are not specific for people with cystic fibrosis. It is also not clear which are the most effective antibiotics. The main purpose of this review was to determine whether treatment with different antibiotic combinations for nontuberculous mycobacterial infection would improve lung function or decrease the frequency of chest infections in people with cystic fibrosis. We did not find any randomized controlled trials which we could include in the review. Randomized controlled trials are needed to inform clinicians which are the best drugs for treating these infections in people with cystic fibrosis. In the meantime, clinicians should follow the current guidelines for the diagnosis and treatment of lung infections due to nontuberculous mycobacteria in the general population.

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    • "Since the important shift in the 1990s away from antituberculous regimes towards macrolide based multidrug therapy [52], not much new has been accomplished in the field of antibiotic treatment of NTM. A part from a current phase 2 trial of inhaled amikacin in the US, a recent Cochrane Review concluded, that not a single randomized trial comparing antibiotic treatment of NTM lung infection in CF has been completed [53]. NTM are notoriously difficult to treat and require multidrug treatment for 12 months or more. "
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    ABSTRACT: Important paradigms of pulmonary disease with nontuberculous mycobacteria (NTM) are currently shifting based on an increasing attention within the field of cystic fibrosis (CF). These shifts are likely to benefit the management of all patients with pulmonary NTM, regardless of underlying pathology. Currently several key areas are being revised: The first outbreak of human NTM transmission has been proven and new evidence of biofilm growth in vivo has been demonstrated. A better understanding of the clinical impact of NTM infection has led to increased diagnostic vigilance and new recommendations for lung transplantation are under way. While recent changes have reinvigorated the interest in NTM disease, the challenge remains, whether such advances can be successfully translated into improved management and care.
    Respiratory research 04/2014; 15(1):41. DOI:10.1186/1465-9921-15-41 · 3.09 Impact Factor
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    ABSTRACT: Although patients with cystic fibrosis (CF) face numerous infectious pathogens over the course of their lifespan, increasing attention has recently been paid to nontuberculous mycobacteria (NTM). As reported prevalence rates rise across many countries such as the United States, the ability to recognize disease caused by NTM and subsequently treat such disease has become increasingly important. This review summarizes new observations on the epidemiology of NTM in CF as well as key elements to consider during the treatment phase. Although overall rates of NTM isolation appear to be increasing, particular concern has focused on the emerging predominance of Mycobacterium abscessus. New data suggest that chronic macrolide therapy now part of routine CF care has contributed to this rise; however, these have yet to be confirmed prospectively. Transmission of M. abscessus between CF patients has also now been described through the use of genome sequencing. Although the greater virulence of M. abscessus makes it a challenging species to treat, identification of the subspecies type can now determine the presence of inducible macrolide resistance, thereby helping to guide treatment. Given increasing prevalence rates, clinicians should maintain a high level of suspicion for NTM as disease-causing organisms in CF, particularly for M. abscessus. New knowledge regarding this species, however, can help to tailor appropriate therapy.
    Current opinion in pulmonary medicine 09/2013; 19(6). DOI:10.1097/MCP.0b013e328365ab33 · 2.76 Impact Factor
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    ABSTRACT: Introduction: Chronic lung infection with Pseudomonas aeruginosa (PsA) is associated with more-rapid pulmonary decline and acute pulmonary exacerbations in patients with cystic fibrosis (CF). The treatment and eradication of this organism from CF airways is particularly difficult, making it the focus of many therapeutic endeavors. Inhaled antibiotics used for PsA treatment help to suppress growth of the organism, maintain lung function and reduce the frequency of pulmonary exacerbations. Areas covered: Herein, the authors discuss the currently available inhaled antibiotics for management of lung infections in CF patients. They also describe the recent results from clinical trials of agents under development, with a focus on liposomal amikacin for inhalation (LAI, Arikace™). The article also provides a summary of the results from relevant articles published in the English. Expert opinion: LAI is a unique formulation of amikacin that enhances drug delivery and retention in CF airways via incorporation into neutral liposomes. Results of a recent Phase II trial suggest that LAI, with the capacity for once-daily dosing and prolonged off-drug periods, may be an attractive choice of inhaled antibiotic to manage PsA lung infections in CF patients. Further data from Phase III studies assessing the efficacy and safety of LAI should better elucidate its potential.
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