Antibiotic treatment for nontuberculous mycobacteria lung infection in people with cystic fibrosis
Abstract
Background
Nontuberculous mycobacteria are mycobacteria, other than those in the Mycobacterium tuberculosis complex, and are commonly found in the environment. Nontuberculous mycobacteria species (most commonly Mycobacterium avium complex and Mycobacterium abscessus) are isolated from the respiratory tract of approximately 5% to 20% of individuals with cystic fibrosis; they can cause lung disease in people with cystic fibrosis leading to more a rapid decline in lung function and even death in certain circumstances. Although there are guidelines for the antimicrobial treatment of nontuberculous mycobacteria lung disease, these recommendations are not specific for people with cystic fibrosis and it is not clear which antibiotic regimen may be the most effective in the treatment of these patients.
Objectives
The objective of our review was to compare antibiotic treatment to no antibiotic treatment, or to compare different combinations of antibiotic treatment, for nontuberculous mycobacteria lung infections in people with cystic fibrosis. The primary objective was to assess the effect of treatment on lung function and pulmonary exacerbations and to quantify adverse events. The secondary objectives were to assess treatment effects on the amount of bacteria in the sputum, quality of life, mortality, nutritional parameters, hospitalizations and use of oral antibiotics.
Search methods
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference abstract books. Date of last search: 13 November 2014.
We also searched a register of ongoing trials and the reference lists of relevant articles and reviews. Date of last search: 24 September 2014.
Selection criteria
Any randomized controlled trials comparing nontuberculous mycobacteria antibiotics to no antibiotic treatment, as well as one nontuberculous mycobacteria antibiotic regimen compared to another nontuberculous mycobacteria antibiotic regimen, in individuals with cystic fibrosis.
Data collection and analysis
Data were not collected because no completed trials were identified by the searches.
Main results
No completed trials were identified by the searches, but one ongoing trial was identified, which may be eligible for inclusion in this review when completed.
Authors' conclusions
This review did not find any evidence for the effectiveness of different antimicrobial treatment for nontuberculous mycobacteria lung disease in people with cystic fibrosis. Until such evidence becomes available, it is reasonable for clinicians to follow the American Thoracic Society guidelines for the diagnosis and treatment of nodular or bronchiectatic pulmonary disease due to Mycobacterium avium complex or Mycobacterium abscessus in patients with cystic fibrosis.
PICOs
Plain language summary
Antibiotic treatment for nontuberculous mycobacteria in people with cystic fibrosis
Nontuberculous mycobacteria are bacteria that are in the same family as tuberculosis and are commonly found in the soil and water. These bacteria can be found in the lungs of people with cystic fibrosis and can cause their lung function to worsen. Although there are guidelines on which antibiotics to use to treat lung infection due to these bacteria, these recommendations are not specific for people with cystic fibrosis. It is also not clear which are the most effective antibiotics. The main purpose of this review was to determine whether treatment with different antibiotic combinations for nontuberculous mycobacterial infection would improve lung function or decrease the frequency of chest infections in people with cystic fibrosis. We did not find any randomized controlled trials which we could include in the review. Randomized controlled trials are needed to inform clinicians which are the best drugs for treating these infections in people with cystic fibrosis. In the meantime, clinicians should follow the current guidelines for the diagnosis and treatment of lung infections due to nontuberculous mycobacteria in the general population.
