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A5917 - Macrolide Resistant Mycobacterium Avium Complex Lung Disease Treated with Bedaquiline
Author Block: J. Philley1, M. S. Devine1, K. M. Calhoun2, R. J. Wallace1, F. Thakkar1, B. A. Brown-Elliott1, E. Iakhiaeva1, S. Molina1, M. Allen1, D. E. Griffith1; 1Univ of Texas Hlth Ctr At Tyler, Tyler, TX, United States, 2Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, United States.
RATIONALE: Macrolide resistant Mycobacterium avium complex (MAC) is difficult to treat and is associated with poor outcomes. Bedaquiline, a diarylquinoline anti-mycobacterial antibiotic that acts by ATP synthase inhibition, was approved for the treatment of drug resistant Mycobacterium tuberculosis (MTB) and has known in vitro activity against MAC. PURPOSE: To describe treatment results of macrolide resistant Mycobacterium avium complex pulmonary disease with antibiotic regimens containing bedaquiline.METHODS: Sputum isolates of macrolide resistant MAC were identified using 23S rRNA gene sequencing. Bedaquiline was administered according to package guidelines in combination with companion drugs given at the discretion of two nontuberculous (NTM) pulmonary physicians. Baseline laboratory values and EKGs were obtained and followed according to package guidelines. Sputum samples for acid fast bacilli (AFB) were obtained monthly unless the patient was unable to produce an adequate specimen. Symptoms were followed at serial visits. Radiographs were obtained at baseline and according to provider discretion on treatment with bedaquiline. RESULTS: A total of 9 patients with macrolide resistant MAC lung disease were treated with a multi-drug regimen which included bedaquiline for an average of 15 months. 6/9 (67%) were women, half of whom had evidence of cavitary disease. 3/9 (33%) were male and all exhibited cavitary disease. An average of 3 companion drugs were used with bedaquiline and all patients had failed prior drug therapy on at least one occasion. A decrease in quantitative sputum culture was noted in 7/9 patients at 6 months (78%). 2/9 (22%) of patients converted and remained culture negative for 1 year on therapy. Improvement in symptoms was noted in 9/9 (100%) of patients. Side effects were minimal with nausea being most often reported (see table) but not requiring termination of therapy. There was no significant prolongation of the QTc interval. CONCLUSION: Treatment options for macrolide resistant MAC lung disease remain limited. Bedaquiline used with companion therapy may be an option for drug resistant disease and appears well tolerated.