From the Guidelines
For patients with cavitary MAC pulmonary disease, a three-drug, macrolide-based regimen with the inclusion of parenteral amikacin or streptomycin is recommended, with treatment administered for at least 12 months after culture conversion. This approach is based on the most recent guidelines for the treatment of nontuberculous mycobacterial pulmonary disease, as outlined in the European Respiratory Journal in 2020 1. The treatment regimen typically involves a daily macrolide-based regimen for patients with cavitary disease, with the parenteral agent administered for at least 2–3 months. Key considerations in the treatment of cavitary consolidation include:
- The use of a macrolide-based regimen as the foundation of treatment
- The addition of parenteral amikacin or streptomycin for patients with cavitary or advanced/severe disease
- Treatment duration of at least 12 months after culture conversion
- The potential need for expert consultation in cases of macrolide-resistant MAC
- The importance of monitoring sputum cultures and adjusting treatment accordingly, with the consideration of adding ALIS to the treatment regimen if cultures have not converted to negative after 6 months of guideline-based treatment 1.
From the Research
Cavitatory Consolidation Treatment
- The treatment of cavitatory consolidation is a complex process, and there is limited research directly addressing this topic 2.
- However, studies on the treatment of bacterial pneumonia and tuberculosis provide some insights into the management of cavitatory lesions.
- A study on the in vitro activity of ceftaroline, ceftriaxone, and vancomycin against methicillin-susceptible and -resistant Staphylococcus aureus found that ceftaroline exhibited improved antibacterial activity compared to vancomycin and ceftriaxone 3.
- Another study compared the outcomes of patients treated with ceftriaxone versus antistaphylococcal antibiotics for definitive treatment of methicillin-susceptible Staphylococcus aureus infections and found no difference in efficacy between the two treatments 4.
- A review of cavitary tuberculosis discussed the epidemiology, clinical features, and standards of care for individuals with cavitary tuberculosis, highlighting the need for specific pharmacological interventions to prevent cavitation and improve lung function 2.
- The use of levofloxacin in combination with standard treatment for Staphylococcus aureus bacteraemia did not decrease mortality or the incidence of deep infections, nor did it speed up recovery 5.
- A study on the post-treatment outcomes of ceftriaxone versus antistaphylococcal penicillins or cefazolin for definitive therapy of methicillin-susceptible Staphylococcus aureus bacteremia found that definitive treatment with ceftriaxone was associated with a higher risk of treatment failure within 90 days 6.
Treatment Options
- Ceftriaxone may be considered for definitive therapy of MSSA infection, with a lower risk of toxicity compared to antistaphylococcal antibiotics 4.
- Ceftaroline may be a viable option for the treatment of bacterial pneumonia, particularly for methicillin-susceptible Staphylococcus aureus infections 3.
- Vancomycin may be used as an alternative treatment option, although its efficacy may vary depending on the specific strain of Staphylococcus aureus 3.