School of Infectious Diseases. Topic: "Treatment of Mycobacteriosis Depending on the Type of NTMB"
Infectious Disease Specialist School. Topic: "Treatment of Mycobacteriosis Depending on the Type of NTMTB."
Lecturer: Vera Nikolaevna Zimina – infectious disease specialist, phthisiologist, Doctor of Medical Sciences, Professor in the Department of Infectious Diseases with courses in Epidemiology and Phthisiology at Peoples' Friendship University of Russia.
00:00:08 Clinical aspects of mycobacteriosis treatment
• Discussion of treatment of patients with mycobacteriosis, including generalized mycobacterial infection.
• Mention the importance of weighing the risks and benefits of treatment, as well as patient support during long-term chemotherapy.
00:05:34 Empirical therapy for generalized mycobacterial infection
• Use of known macrolides, clarithromycin or azithromycin, antabutol, and rifomycin or rifobutin.
• Monitoring the disease based on clinical manifestations, laboratory parameters, and radiographic diptych.
00:09:43 Duration of Treatment and Prevention of Mycobacteriosis
• The course of treatment for generalized mycobacterial infection should be at least 12 months.
• Prevention of mycobacteriosis in HIV-infected patients with a CD4 count of less than 50 cells.
00:11:52 Treatment of Pulmonary Mycobacteriosis
• No adjustment of antiretroviral therapy is required when prescribing macrolides and rifampin.
• When prescribing clarithromycin and non-neot drugs, precautions should be taken.
• Azithromycin has a lower potential for interactions with other drugs.
00:14:08 Monitoring and Treatment of Patients with Pulmonary Mycobacteriosis
•The decision to withdraw is based on factors related to the progression of mycobacteriosis (e.g., sarcoidosis).
•Monitoring: repeat imaging studies no more than every 6 months.
00:16:16 Empirical Therapy and Treatment Outcomes
•Treatment for pulmonary mycobacteriosis differs from that for tuberculosis alone.
•Treatment duration: at least 12 months after sputum conversion.
•Treatment outcomes: cure, clinical recovery, treatment failure, relapse.
00:21:55 Drug Susceptibility Testing
•The Citi system is recommended for determining drug resistance in non-tuberculous mycobacteria.
•Drug susceptibility testing should be interpreted only according to protocols preferred by the testing site.
00:23:42 Mycobacteriosis and its treatment
•Mycobacteriosis can be slow-growing or rapidly growing, and understanding which group is the causative agent is important for medical decision-making.
•For slow-growing mycobacteria, there is a drug susceptibility testing panel, but only four drugs are relevant for reaction assessment: clarithromycin, mycocin, zalit, and moxifloxacin.
•For the treatment of Maca infection, the most common causative agent of mycobacteriosis, refpci and tambuto are commonly used.
00:32:20 Treatment of mycobacteriosis
•For the treatment of rapidly growing mycobacteria, drug susceptibility testing is used, as well as therapy regimens based on the causative agent.
• The treatment efficacy of mycobacteriosis is significantly lower than that of tuberculosis, and the most successful results are achieved with the eradication of mycobacteriosis caused by Mycobacterium kansasi.
00:35:51 Review of Mycobacteriosis Treatment Efficacy
• This review presents data on the eradication of mycobacteriosis caused by slow-growing mycobacteria, such as MAC, Xeno, and Mamanca.
• Treatment efficacy is only 28%, indicating a disappointing treatment prognosis.
00:36:55 Conclusions and Treatment Prospects
• Treatment results for mycobacteriosis are currently unsatisfactory, and drug susceptibility testing can only be used under certain conditions.
•For rapidly growing mycobacteria, treatment should be based on drug susceptibility testing, while for slower-growing mycobacteria, treatment should be based on four antimicrobial agents: clarithromycin, amikacin, moxifloxacin, and linezolid.
•Various inhaled forms of amikacin are used to treat pulmonary mycobacteriosis, but these are not yet available in Russia.
•Prospects for treating mycobacteriosis using new drugs such as bedaquiline, linezolid, crofazimine, and sildenafil.