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LETTER TO EDITOR
Year : 2018  |  Volume : 7  |  Issue : 4  |  Page : 394

Macrolides and mycobacterium abscessus abscessus: A good idea?


Department of Paediatric Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh, Scotland

Date of Web Publication5-Dec-2018

Correspondence Address:
Ross John Langley
Department of Paediatric Respiratory Medicine, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, Eh9 1Lf
Scotland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_127_18

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How to cite this article:
Langley RJ, Urquhart DS. Macrolides and mycobacterium abscessus abscessus: A good idea?. Int J Mycobacteriol 2018;7:394

How to cite this URL:
Langley RJ, Urquhart DS. Macrolides and mycobacterium abscessus abscessus: A good idea?. Int J Mycobacteriol [serial online] 2018 [cited 2018 Dec 11];7:394. Available from: http://www.ijmyco.org/text.asp?2018/7/4/394/246914



Sir,

We read with interest the article by Tippett et al. describing the natural history and treatment outcomes of Mycobacterium abscessus complex (M. ab complex) in a large, adult cystic fibrosis (CF) center.[1] We agree with the authors that questions remain regarding the optimal treatment options and that research is urgently mandated to understand the best therapeutic approach to each subspecies within the complex.

The authors' exploration of the effects of prophylactic azithromycin is of particular interest to us, especially in the M. ab. complex subspecies, that carry an inducible macrolide resistance (Erm) gene.[2] We hypothesize that the use of macrolides as part of treatment regimens for all members of the M. ab complex[3] may actively select and negatively affect the eradication of M. abscessus abscessus which, by definition, carries the Erm gene.[4]

Although criteria for the treatment of nontuberculous mycobacteria pulmonary disease (NTM-PD) are not stated, it is noted that all four M. abscessus abscessus colonized subjects (nos. 26, 27, 28, and 32) within the persistent colonization/treatment (n = 7) group [Table 3] [1] had all received prophylactic azithromycin; while in all subjects in whom spontaneous clearance of M. ab. complex was demonstrated, none had received prophylactic azithromycin, though only one patient was infected with M. abscessus abscessus (no. 37).{Table 3}

The authors state that “the use of prophylactic antibiotics did not appear to be ‘protective for the acquisition of M. ab complex species’.” Alternatively, these data may support the hypothesis that azithromycin could be deleterious in this regard by encouraging selection and promoting M. abscessus abscessus growth within the CF airway. Further studies of the epidemiology of M. ab. complex in CF appear warranted.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tippett E, Ellis S, Wilson J, Kotsimbos T, Spelman D. Mycobacterium abscessus complex: Natural history and treatment outcomes at a tertiary adult cystic fibrosis center. Int J Mycobacteriol 2018;7:109-16.  Back to cited text no. 1
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2.
Langley RJ, Peters C, Bowhay S, Urquhart D. Macrolides and Mycobacterium abscessus-Time for a Rethink. Available from: https://thorax.bmj.com/content/72/Suppl_2/ii1.responses. [Last accessed on 2018 Sep].  Back to cited text no. 2
    
3.
Haworth CS, Banks J, Capstick T, Fisher AJ, Gorsuch T, Laurenson IF, et al. British thoracic society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax 2017;72:ii1-64.  Back to cited text no. 3
    
4.
Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene, Erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother 2009;53:1367-76.  Back to cited text no. 4
    




 

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