A HIV negative patient with severe pulmonary MAC diseases is not improved with therapy including clarithromycin, ethambutol, moxifloxacin, rifampin.
MAC was resistant to clarithromycin, ethambutol, moxifloxacin, rifampin, amikacin, streptomycin.
Therapy of MAC infections of non-HIV patients is difficult (1). When you have across the board resistance as your question indicates, any current therapy is probably ineffective. When all else has failed and there is nothing available, one can treat the patient under compassionate basis that will improve quality of life and perhaps, bring about some relieve, if not a cure. We have shown that the use the old neuroleotic thiordazine will improve the quality of life of XDR TB patients and has been recommended as a salvage drug (2). In vitro, small quantities of thioridazine will render MAC strains susceptible to many second line drugs to which the strain was initially resistant (3). The positive in vitro responses are opined to be the result of inhibition of over-expressed efflux pumps which extrude the antibiotics before they reach their intended target (4). I suggest these cited papers for more complete info.
1. Ramirez J, Mason C, Ali J, Lopez FA. Mycobacterium avium complex pulmonary
disease: management options in HIV-negative patients. J La State Med Soc. 2008
Sep-Oct;160(5):248-54; quiz 254, 293. PubMed PMID: 19048978.
2a. Amaral L, Udwadia Z, Abbate E, van Soolingen D. The added effect of
thioridazine in the treatment of drug-resistant tuberculosis. Int J Tuberc Lung
Dis. 2012 Dec;16(12):1706-8; author reply 1708-9. doi: 10.5588/ijtld.12.0616.
PubMed PMID: 23131273.
2b. Amaral L, Boeree MJ, Gillespie SH, Udwadia ZF, van Soolingen D. Thioridazine
cures extensively drug-resistant tuberculosis (XDR-TB) and the need for global
trials is now! Int J Antimicrob Agents. 2010 Jun;35(6):524-6. doi:
10.1016/j.ijantimicag.2009.12.019. Epub 2010 Feb 25. Review. PubMed PMID:
20188526.
3. Viveiros M, Martins M, Couto I, Kristiansen JE, Molnar J, Amaral L. The in
vitro activity of phenothiazines against Mycobacterium avium: potential of
thioridazine for therapy of the co-infected AIDS patient. In Vivo. 2005
Jul-Aug;19(4):733-6. PubMed PMID: 15999542.
4a. Viveiros M, Martins M, Rodrigues L, Machado D, Couto I, Ainsa J, Amaral L.
Inhibitors of mycobacterial efflux pumps as potential boosters for
anti-tubercular drugs. Expert Rev Anti Infect Ther. 2012 Sep;10(9):983-98. doi:
10.1586/eri.12.89. Review. PubMed PMID: 23106274.
4b. Machado D, Couto I, Perdigão J, Rodrigues L, Portugal I, Baptista P, Veigas B,
Amaral L, Viveiros M. Contribution of efflux to the emergence of isoniazid and
multidrug resistance in Mycobacterium tuberculosis. PLoS One. 2012;7(4):e34538.
doi: 10.1371/journal.pone.0034538. Epub 2012 Apr 6. PubMed PMID: 22493700; PubMed Central PMCID: PMC3321020.
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