Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysis

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-02-20 DOI:10.1016/j.jiph.2025.102711

Van-Dong Nguyen , Hai Duong , Ming-Chia Lee , Jin-Hua Chen , Wei-Chang Huang , Hsiao-En Chen , Jung-Chun Lin , Jann-Yuan Wang , Chih-Hsin Lee

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Abstract

Background

Mycobacterium avium complex (MAC) infection, requiring prolonged treatment with an antibiotic combination, is an emerging public health concern.

Methods

This meta-analysis compared the efficacy of 2-drug regimens with that of 3-drug regimens in bacteriological responses, acquired macrolide resistance (AMR), and mortality among adult patients with disseminated MAC infection (DMAC) and MAC pulmonary disease (MAC-PD).

Results

Seven randomized controlled trials (RCTs) and 3 non-RCT studies, encompassing 1369 patients, were included. Treating DMAC with 2-drug regimens was associated with comparable bacteriological responses (odds ratio (OR) = 0.76, 95 % confidence interval (CI) = 0.48–1.18, P = .22) and mortality (OR = 1.29, 95 % CI = 0.59–2.83, P = .52), but had a higher risk of AMR (OR = 2.99, 95 % CI = 1.10–8.13, P = .03). For MAC-PD, 2-drug regimens were noninferior to 3-drug regimens in bacteriological responses (OR = 0.82, 95 % CI = 0.53–1.25, P = .35) and AMR (risk differences (RD) = 0.01, −0.02 to 0.05, P = .39), with no observed mortalities. Although not statistically significant compared to the 3-drug regimen, the macrolide–rifamycin regimen resulted in attenuated bacteriological responses (OR = 0.51, 95 % CI = 0.14–1.90, P = .32). However, the proportion of patients with bacteriological response (OR = 1.54, 95 % CI = 0.78–2.93, P = .23) and AMR risk (RD = 0.01, −0.02 to 0.04, P = .50) was not different between those under the macrolide-ethambutol regimen and those under 3-drug regimens.

Conclusions

The macrolide–ethambutol 2-drug regimen may be a viable alternative option for treating MAC-PD, whereas DMAC can be preferably managed with a 3-drug regimen.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.