Combined administration of rifampicin, ethambutol, and clarithromycin for the treatment of tenosynovitis of the hand caused by Mycobacterium avium complex

Abstract

We report the clinical results and problems of combined administration of rifampicin, ethambutol, and clarithromycin (REC) for the treatment of Mycobacterium avium complex (MAC) infection of the hand (hand MAC). Participants included 7 patients with hand MAC. After resection of the infected lesion, REC was prescribed for 12 months. For these patients, the site of infection, clinical course after initiation of REC, adverse drug effects (ADEs), and incidence of recurrence were evaluated. Sites of infection were the flexor tenosynovium in 5 patients, extensor tenosynovium in 1 patient, and both flexor and extensor tenosynovium in 1 patient. ADEs of REC occurred in 5 patients, and included visual disturbance caused by ethambutol in 2 patients, liver function abnormality caused by rifampicin in 2 patients, and fever with diarrhea caused by rifampicin in 1 patient. For 2 of these 5 patients, desensitization therapy was applied and REC was able to be reinstated. In the remaining 3 patients, the causative drugs were discontinued and levofloxacin, a new quinolone, was administered. Complete healing was achieved in 5 patients, and recurrence was observed in 2 patients. These 2 patients with recurrence included 1 patient in whom REC was completed and 1 patient in whom REC therapy was modified due to ADE. REC provided relatively good clinical results as a treatment for hand MAC. However, recurrences were observed even after the completion of REC and the use of an alternative drug. Optimal duration of REC and appropriate alternative drugs need to be identified in the future.

Mycobacterium avium complex prosthetic joint infection: A systematic review of the literature and pooled analysis

“…3 There is a lack of clear evidence suggesting that a shorter duration of antibiotic therapy would yield equally successful outcomes, and recurrence may occur even after the completion of long term combination therapy. 10 Notably, the median duration of active anti-MAC antibiotic therapy among survivors in our study analysis was 12 months. Therefore, the duration of active anti-MAC antibiotic therapy may be considered for approximately 12 months for those who underwent surgery without complication and for longer than 12 months for those who did not have surgery or who found to have complications after the surgery.…”

“…Until now, macrolide (azithromycin or clarithromycin), ethambutol, and rifampin have been considered the drugs of choice for the treatment in the majority of the reports. 3,10,29 The recent guideline 24 for MAC pulmonary disease recommends 3-drug therapy including a macrolide and ethmbutol over 2-drug regimen. Addition of rifamycin such as rifabutin or rifampin may prevent the development of macrolide resistance during the antibiotic therapy.…”

“…The exclusion criteria were (1) articles without data on patient risk factors for infection (immunocompromising conditions), (2) assessment of any other joints beyond the realm of the hip and knee joint, 10 (3) non-English articles, (4) abstracts only, (5) conference presentations, and (6) native joint infection (septic arthritis) before arthroplasty. 11,12 Given the dearth of substantial evidence pertaining to this topic, our review predominantly encompasses case reports and case series to provide a comprehensive analysis.…”

Atypical Mycobacterial Tenosynovitis in the Setting of Adalimumab Use

“…NTM infection is overall uncommon in immunocompetent hosts, with respiratory infection being the most common, with reported rates over 90% [2,4]. Underlying diseases such as emphysema, bronchiectasis, prior tuberculosis infection, rheumatoid arthritis, cystic fibrosis, and other chronic pulmonary conditions can predispose patients to NTM disease.…”

“…When infection does involve the MSK system, hand and wrist involvement are most often reported. This has been hypothesized due to the rich synovial fluid environment present in these regions [2,4]. Of these patients, tenosynovitis is less common than arthritis or osteomyelitis [5].…”