Extract
5 years ago, a then 50-year-old woman presented with long-standing fatigue, dyspnoea and a chronic productive cough. Based on a computed tomography scan of the thorax and multiple positive cultures, she was diagnosed with nodular–bronchiectatic Mycobacterium avium pulmonary disease; she was also found to have a heterozygous F508del CFTR gene mutation. She commenced therapy with rifabutin 300 mg once daily, ethambutol 1200 mg once daily and azithromycin 500 mg once daily. After 15 months of ongoing symptoms, radiographic deterioration and persistent culture positivity, clofazimine 100 mg once daily and thrice weekly intravenous amikacin 15 mg·kg−1 were added to the regimen. Amikacin was halted after 4 months; the remaining four drugs were continued. The dose of azithromycin was lowered to 250 mg once daily after 9 months because of hearing loss.
Abstract
In its current dose, bedaquiline is probably not a viable treatment option for treatment-refractory MAC-PD; even with adequate exposure, treatment fails due to acquired resistance documented by increasing MICs and whole-genome sequencing http://bit.ly/2YvaTMM
Footnotes
Conflict of interest: S.M.H. Zweijpfenning has nothing to disclose.
Conflict of interest: J.A. Schildkraut has nothing to disclose.
Conflict of interest: J.P.M. Coolen has nothing to disclose.
Conflict of interest: C. Ruesen has nothing to disclose.
Conflict of interest: E. Koenraad has nothing to disclose.
Conflict of interest: A. Janssen has nothing to disclose.
Conflict of interest: M.M. Ruth has nothing to disclose.
Conflict of interest: A.S. de Jong has nothing to disclose.
Conflict of interest: S. Kuipers has nothing to disclose.
Conflict of interest: R.E. Aarnoutse has nothing to disclose.
Conflict of interest: C. Magis-Escurra has nothing to disclose.
Conflict of interest: W. Hoefsloot has nothing to disclose.
Conflict of interest: J. van Ingen reports grants from Netherlands Organization for Scientific Research (NWO/ZonMW grant Veni 016.176.024), during the conduct of the study.
Support statement: J. van Ingen is supported by a personal grant from the Netherlands Organization for Scientific Research (NWO/ZonMW grant Veni 016.176.024). Funding information for this article has been deposited with the Crossref Funder Registry.
- Received January 16, 2019.
- Accepted March 24, 2019.
- Copyright ©ERS 2019
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