Volume 25, Number 7—July 2019
CME ACTIVITY - Synopsis
Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001–2013
, Hannah Chung, Michael A. Campitelli, Jeffrey C. Kwong, Alex Marchand-Austin, Kevin L. Winthrop, Frances B. Jamieson, and Theodore K. Marras
Table 2
Proportion of patients with MAC PD and M. xenopi PD who had ever received each antimicrobial drug and select drug combinations and duration during first treatment episode, Ontario, Canada, 2001–2013*
| Treatment† | MAC PD, n = 688 |
M. xenopi PD, n = 142 |
|||
|---|---|---|---|---|---|
| No. (%) | Mean duration ± SD, d | No. (%) | Mean duration ± SD, d | ||
| Individual drug | |||||
| Macrolide | |||||
| Any | 599 (87.1) | 447 ± 367 | 120 (84.5) | 359 ± 312 | |
| Clarithromycin | 318 (46.2) | 369 ± 364 | 66 (46.5) | 319 ± 367 | |
| Azithromycin | 354 (51.5) | 424 ± 348 | 66 (46.5) | 335 ± 244 | |
| Rifamycin | |||||
| Any | 403 (58.6) | 437 ± 366 | 69 (48.6) | 349 ± 228 | |
| Rifampin | 384 (55.8) | 434 ± 363 | 61 (43.0) | 351 ± 233 | |
| Rifabutin | 30 (4.4) | 323 ± 285 | 9 (6.3) | 294 ± 217 | |
| Ethambutol | 483 (70.2) | 456 ± 357 | 84 (59.2) | 363 ± 284 | |
| Fluoroquinolone | |||||
| Any | 232 (33.7) | 369 ± 353 | 63 (44.4) | 312 ± 189 | |
| Moxifloxacin | 82 (11.9) | 318 ± 382 | 27 (19.0) | 251 ± 195 | |
| Levofloxacin | 56 (8.1) | 226 ± 239 | 11 (7.7) | 240 ± 282 | |
| Ciprofloxacin | 137 (19.9) | 328 ± 333 | 36 (25.4) | 283 ± 181 | |
| Gatifloxacin | ≤5 (≤0.7) | 126 ± 163 | 0 | NA | |
| Norfloxacin | 8 (1.2) | 197 ± 288 | 0 | NA | |
| Linezolid | 0 | NA | 0 | NA | |
| Isoniazid |
NA |
NA |
<5 (<3.5) |
160 ± 110 |
|
| Drug regimen | |||||
| Standard triple: macrolide + ethambutol + rifamycin ± others | 326 (47.4) | 369 ±269 | 51 (35.9) | 241 ± 173 | |
| Macrolide + ethambutol | 91 (13.2) | 315 ± 283 | 11 (7.7) | 159 ± 83 | |
| Macrolide + rifamycin | 49 (7.1) | 284 ± 392 | 10 (7.0) | 251 ± 208 | |
| Macrolide + fluoroquinolone | 65 (9.4) | 267 ± 278 | 20 (14.1) | 228 ± 153 | |
| Other macrolide-containing combinations‡ | 115 (16.7) | 346 ±276 | 31 (21.8) | 295 ± 156 | |
| Nonmacrolide combination§ | 63 (9.2) | 258 ± 298 | 19 (13.4) | 198 ± 187 | |
| Macrolide monotherapy | 141 (20.5) | 262 ± 358 | 34 (23.9) | 330 ± 509 | |
| Nonmacrolide monotherapy | 201 (29.2) | 206 ± 226 | 40 (28.2) | 253 ± 207 | |
| No. drugs given, mean ± SD | 2.5 ± 0.9 | 2.4 ± 1.0 | |||
| No. drugs given | |||||
| 1 | 142 (20.6) | 37 (26.1) | |||
| 2 | 121 (17.6) | 24 (16.9) | |||
| 3 | 372 (54.1) | 69 (48.6) | |||
| 4 | 53 (7.7) | 12 (8.5) | |||
| No. switched regimens¶ | |||||
| 0 | 401 (58.3) | 85 (59.9) | |||
| 1 | 177 (25.7) | 33 (23.2) | |||
| 2 | 72 (10.5) | 14 (9.9) | |||
| >3 |
38 (5.5) |
10 (7.0) |
|||
| Maximum no. drugs used at any 1 time, mean ± SD | 2.4 ± 0.9 | 2.3 ± 0.9 | |||
*MAC, Mycobacterium avium complex; M. xenopi, Mycobacterium xenopi; PD, pulmonary disease.
†>60 continuous d of treatment with >1 drugs/classes commonly used to treat MAC PD or M. xenopi PD (macrolide, ethambutol, rifamycin, fluoroquinolone, linezolid, inhaled amikacin, or for M. xenopi PD, isoniazid), started within 1 y of any positive culture for the causative nontuberculous mycobacteria species/complex. Patients may have received >1 drug from an antibiotic class, and/or>1antibiotic regimen during their first treatment episode, so values do not add up to 100%. According to privacy regulations, values representing <6 persons are reported as <5, and data are presented as a range of values for categorical variables where back-calculation is possible.
‡>2 drugs excluding: macrolide + fluoroquinolone, macrolide + EMB, macrolide + rifamycin.
§>2 drugs (e.g., ethambutol, a rifamycin, a fluoroquinolone (or for M. xenopi PD, isoniazid), without macrolide.
¶Change in treatment lasting >60 d, in the first treatment episode.