minocycline and Tuberculosis--Pulmonary

An open clinical trial for the treatment of Mycobacterium avium intracellulare complex (MAIC) lung disease in human immunodeficiency virus (HIV)-seronegative patients.. To assess the efficacy and tolerance of clarithromycin (0.75-2 g/day) combined with minocycline (200 mg/day) and clofazimine (100 mg/day) for 15 months.. The study was carried out from August 1992 to June 1994 by pulmonologists of various French medical centres. The patients to be enrolled were of either sex, over 18 years of age, HIV-seronegative and suffering from MAIC lung disease, with a confirmed bacteriological and radiological diagnosis. Examinations were to be performed after 1, 2, 3, 6, 9, 12 and 15 months of treatment.. Thirty patients were included, 16 males and 14 females. Eight did not complete the study due to deviations from protocol or adverse effects. The remainder completed the study with a post-treatment follow-up of 27 +/- 7 months. Among the 22 evaluable patients, 18 had a history of lung disease. Tolerance to the drugs was generally good, apart from three cases of hepatic disturbances and three cases of ototoxicity, which required a decrease in clarithromycin dosage after a short interruption of treatment. There were 14 treatment successes, seven treatment failures, defined by absence of bacteriologic conversion, and in one patient the disease evolution remains uncertain.. The combination of clarithromycin with minocycline and clofazimine proved effective with persistently negative cultures in 64% of the patients, and an overall good drug tolerance.

Topics: Adult; Aged; Anti-Bacterial Agents; Clarithromycin; Clofazimine; Drug Administration Schedule; Drug Therapy, Combination; Female; HIV Seronegativity; Humans; Male; Middle Aged; Minocycline; Mycobacterium avium-intracellulare Infection; Treatment Outcome; Tuberculosis, Pulmonary

In the Horn of Africa, there is a high prevalence of tuberculosis that is reported to be partly driven by multidrug-resistant (MDR) Mycobacterium tuberculosis strictu sensu strains. We conducted a prospective study to investigate M. tuberculosis complex species causing tuberculosis in Djibouti, and their in vitro susceptibility to standard anti-tuberculous antibiotics in addition to clofazimine, minocycline, chloramphenicol and sulfadiazine. Among the 118 mycobacteria isolates from 118 successive patients with suspected pulmonary tuberculosis, 111 strains of M. tuberculosis, five Mycobacterium canettii, one 'Mycobacterium simulans' and one Mycobacterium kansasii were identified. Drug-susceptibility tests performed on the first 78 isolates yielded nine MDR M. tuberculosis isolates. All isolates were fully susceptible to clofazimine, minocycline and chloramphenicol, and 75 of 78 isolates were susceptible to sulfadiazine. In the Horn of Africa, patients with confirmed pulmonary tuberculosis caused by an in vitro susceptible strain may benefit from anti-leprosy drugs, sulfamides and phenicol antibiotics.

Topics: Adult; Antitubercular Agents; Chloramphenicol; Clofazimine; Djibouti; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Mycobacterium kansasii; Mycobacterium tuberculosis; Prospective Studies; Sulfadiazine; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

Mycobacterium abscessus complex and other non-tuberculous mycobacteria are infrequently encountered respiratory pathogens in patients with tracheostomies. We report a 4-year-old girl with a tracheostomy, placed during infancy for management of severe bronchopulmonary dysplasia and laryngeal stenosis, who developed a M. abscessus complex lung infection. There was clear evidence of parenchymal involvement and true infection beyond colonization. She demonstrated dramatic clinical, laboratory, and radiographic improvement after prolonged anti-mycobacterial therapy.

Topics: Amikacin; Anti-Bacterial Agents; Bronchopulmonary Dysplasia; Child, Preschool; Clarithromycin; Female; Humans; Laryngostenosis; Minocycline; Mycobacterium Infections, Nontuberculous; Tigecycline; Tomography, X-Ray Computed; Tracheostomy; Tuberculosis, Pulmonary

A 33-year male was readmitted to our hospital for the treatment of multi-drug resistant pulmonary tuberculosis in February 1993. Six years after the treatment, the left pleuropneumonectomy was done because of the enlargement of cavitary lesions with formation of fluid. Four years after the operation, M. tuberculosis from the patient was resistant to all first- and second-line anti-tuberculosis drugs. Apical lesion and cavitary lesion on the upper lung were still seen on chest X ray and sputum smear and culture were continuously positive. Minocycline and gatifloxacin were prescribed after five years of the operation. Sixteen months after changing the regimen sputum smear and culture converted negative. Chemotherapy was terminated in August 2007, two years after the negative conversion. One year after the termination of treatment no relapse occurred. We considered minocycline was effective in this case, because gatifloxacin was resistant by the drug susceptibility test and was previously used.

Topics: Adult; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Humans; Male; Minocycline; Mycobacterium tuberculosis; Pneumonectomy; Sputum; Treatment Outcome; Tuberculosis, Pulmonary

A 58-year-old man was admitted to our hospital because of an abnormal shadow found on chest radiography. Chest radiographs and chest CT on admission showed a bulla with a niveau and infiltration in the right upper lobe. Smear of sputum and bronchial lavage were negative for acid-fast bacilli. Despite treatment with meropenem and clindamycin, the infiltrating shadow worsened. Since bronchial lavage and sputum culture were positive for M. fortuitum, these drugs were replaced with minocycline and imipenem. Thereafter, the shadow on the chest radiograph improved. After discharge, outpatient treatment with clarithromycin and levofloxacin was continued. After 4 months, the residual tumor shadow in the right upper lobe gradually grew. When a CT-guided transcutaneous needle lung biopsy was undertaken, malignant cells were found. Right upper lobectomy was performed. Pathological examination of the lesion demonstrated small-cell lung cancer. If a lesion does not change after nontuberculous mycobacteria treatment, the physician should consider other lesions such as lung cancer.

Topics: Anti-Bacterial Agents; Carcinoma, Small Cell; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Humans; Imipenem; Lung Neoplasms; Male; Middle Aged; Minocycline; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Radiography, Thoracic; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

We report a case of lung infection due to Mycobacterium abscessus (M. abscessus). A 60 year-old woman was admitted to our hospital because of an abnormal shadow found on chest radiography and a bloody sputum. Chest radiography revealed infiltrative and linear shadows in the middle and lower fields of both lungs. The sputum smears were negative for acid-fast bacilli, but sputum culture was positive. Rapidly growing mycobacteria were detected. The patient was treated with clarithromycin. Since M. abscessus was identified from repeated cultures of the sputa, the patient was treated with Imipenem/Cilastatin and Amikacin for four weeks, during which the chest radiography improved. After discharge, the treatment with clarithromycin and minocycline was continued for ten months, and the chest radiography improved further. Our treatment for M. abscessus may be a useful choice for drug treatment of such cases.

Topics: Amikacin; Cilastatin; Cilastatin, Imipenem Drug Combination; Clarithromycin; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Middle Aged; Minocycline; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous; Radiography; Sputum; Tuberculosis, Pulmonary

We report a case of disseminated Mycobacterium fortuitum in a 76-yr-old male with no identifiable predisposing factors except chronic interstitial lung disease. Recurrent, progressive pulmonary symptoms and radiographic findings were followed by the development of multiple, culture-positive peripheral lesions. The patient responded rapidly and completely to combination therapy consisting primarily of ciprofloxacin, minocycline, and surgical drainage. Our experience supports the cautious use and further study of fluorinated quinolones for M. fortuitum infections caused by susceptible isolates.

Topics: Aged; Ciprofloxacin; Combined Modality Therapy; Drainage; Humans; Male; Minocycline; Mycobacterium Infections, Nontuberculous; Tetracyclines; Tuberculosis, Cutaneous; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary

Topics: Aged; Drug Therapy, Combination; Female; Humans; Leucomycins; Male; Middle Aged; Minocycline; Mycobacterium avium; Mycobacterium Infections, Nontuberculous; Sulfadimethoxine; Tetracyclines; Tuberculosis, Pulmonary

Topics: Adult; Aged; Antitubercular Agents; Drug Evaluation; Female; Humans; Male; Middle Aged; Minocycline; Mycobacterium Infections, Nontuberculous; Tetracyclines; Tuberculosis, Pulmonary