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| LETTER TO EDITOR |
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| Year : 2018 | Volume
: 7
| Issue : 4 | Page : 394 |
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Macrolides and mycobacterium abscessus abscessus: A good idea?
Ross John Langley, Donald S Urquhart
Department of Paediatric Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh, Scotland
| Date of Web Publication | 5-Dec-2018 |
Correspondence Address:
Ross John Langley
Department of Paediatric Respiratory Medicine, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, Eh9 1Lf
Scotland
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijmy.ijmy_127_18
How to cite this article:
Langley RJ, Urquhart DS. Macrolides and mycobacterium abscessus abscessus: A good idea?. Int J Mycobacteriol 2018;7:394 |
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 | |  |
| 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.  [ PUBMED] [Full text] |
| 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. |
| 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. |
| This article has been cited by | | 1 |
Treating Primary Arthroprosthesis Infection Caused by Mycobacterium abscessus subsp. abscessus |
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| Valerio Pace,Pierluigi Antinolfi,Emanuele Borroni,Daniela Maria Cirillo,Elio Cenci,Claudio Piersimoni,Angela Cardaccia,Marco Nofri,Chiara Papalini,Rosario Petruccelli,Fabrizio Marzano,Maria Bruna Pasticci | | Case Reports in Infectious Diseases. 2019; 2019: 1 | | [Pubmed] | [DOI] | |
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