Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001–2013

• Main Authors: Sarah K. Brode, Hannah Chung, Michael A. Campitelli, Jeffrey C. Kwong, Alex Marchand-Austin, Kevin L. Winthrop, Frances B. Jamieson, Theodore K. Marras
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 2019-07-01
• Series: Emerging Infectious Diseases
• Subjects: Nontuberculous mycobacteria; Mycobacterium infections; nontuberculous; Mycobacterium avium complex; tuberculosis and other mycobacteria; treatment
• Online Access: https://wwwnc.cdc.gov/eid/article/25/7/18-1817_article

Surveys suggest that clinicians diverge from guidelines when treating Mycobacterium avium complex (MAC) pulmonary disease (PD). To determine prescribing patterns, we conducted a cohort study of adults >66 years of age in Ontario, Canada, with MAC or Mycobacterium xenopi PD during 2001–2013. Using linked laboratory and health administrative databases, we studied the first treatment episode (>60 continuous days of >1 of a macrolide, ethambutol, rifamycin, fluoroquinolone, linezolid, inhaled amikacin, or, for M. xenopi, isoniazid). Treatment was prescribed for 24% MAC and 15% of M. xenopi PD patients. Most commonly prescribed was the recommended combination of macrolide, ethambutol, and rifamycin, for 47% of MAC and 36% of M. xenopi PD patients. Among MAC PD patients, 20% received macrolide monotherapy and 33% received regimens associated with emergent macrolide resistance. Although the most commonly prescribed regimen was guidelines-recommended, many regimens prescribed for MAC PD were associated with emergent macrolide resistance.