Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysis
Background: Mycobacterium avium complex (MAC) infection, requiring prolonged treatment with an antibiotic combination, is an emerging public health concern. Methods: This meta-analysis compared the efficacy of 2-drug regimens with that of 3-drug regimens in bacteriological responses, acquired macrol...
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Elsevier
2025-05-01
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| Series: | Journal of Infection and Public Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034125000607 |
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| author | Van-Dong Nguyen Hai Duong Ming-Chia Lee Jin-Hua Chen Wei-Chang Huang Hsiao-En Chen Jung-Chun Lin Jann-Yuan Wang Chih-Hsin Lee |
| author_facet | Van-Dong Nguyen Hai Duong Ming-Chia Lee Jin-Hua Chen Wei-Chang Huang Hsiao-En Chen Jung-Chun Lin Jann-Yuan Wang Chih-Hsin Lee |
| author_sort | Van-Dong Nguyen |
| collection | DOAJ |
| description | Background: Mycobacterium avium complex (MAC) infection, requiring prolonged treatment with an antibiotic combination, is an emerging public health concern. Methods: This meta-analysis compared the efficacy of 2-drug regimens with that of 3-drug regimens in bacteriological responses, acquired macrolide resistance (AMR), and mortality among adult patients with disseminated MAC infection (DMAC) and MAC pulmonary disease (MAC-PD). Results: Seven randomized controlled trials (RCTs) and 3 non-RCT studies, encompassing 1369 patients, were included. Treating DMAC with 2-drug regimens was associated with comparable bacteriological responses (odds ratio (OR) = 0.76, 95 % confidence interval (CI) = 0.48–1.18, P = .22) and mortality (OR = 1.29, 95 % CI = 0.59–2.83, P = .52), but had a higher risk of AMR (OR = 2.99, 95 % CI = 1.10–8.13, P = .03). For MAC-PD, 2-drug regimens were noninferior to 3-drug regimens in bacteriological responses (OR = 0.82, 95 % CI = 0.53–1.25, P = .35) and AMR (risk differences (RD) = 0.01, −0.02 to 0.05, P = .39), with no observed mortalities. Although not statistically significant compared to the 3-drug regimen, the macrolide–rifamycin regimen resulted in attenuated bacteriological responses (OR = 0.51, 95 % CI = 0.14–1.90, P = .32). However, the proportion of patients with bacteriological response (OR = 1.54, 95 % CI = 0.78–2.93, P = .23) and AMR risk (RD = 0.01, −0.02 to 0.04, P = .50) was not different between those under the macrolide-ethambutol regimen and those under 3-drug regimens. Conclusions: The macrolide–ethambutol 2-drug regimen may be a viable alternative option for treating MAC-PD, whereas DMAC can be preferably managed with a 3-drug regimen. |
| format | Article |
| id | doaj-art-6f1f1e8fdba34bbca8a715f783737eac |
| institution | DOAJ |
| issn | 1876-0341 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | Journal of Infection and Public Health |
| spelling | doaj-art-6f1f1e8fdba34bbca8a715f783737eac2025-08-20T03:08:24ZengElsevierJournal of Infection and Public Health1876-03412025-05-0118510271110.1016/j.jiph.2025.102711Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysisVan-Dong Nguyen0Hai Duong1Ming-Chia Lee2Jin-Hua Chen3Wei-Chang Huang4Hsiao-En Chen5Jung-Chun Lin6Jann-Yuan Wang7Chih-Hsin Lee8International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Intensive Care Unit, Danang Hospital, Danang, Viet NamDepartment of Community Health, School of Medicine, Vietnam National University, Ho Chi Minh City, Viet NamDepartment of Pharmacy, New Taipei City Hospital, New Taipei City, Taiwan; School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, TaiwanPulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan; Institutional Research Center, Office of Data Science, Taipei Medical University, Taipei, TaiwanDivision of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, TaiwanPulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, TaiwanSchool of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanPulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Correspondence to: 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116079, TaiwanBackground: Mycobacterium avium complex (MAC) infection, requiring prolonged treatment with an antibiotic combination, is an emerging public health concern. Methods: This meta-analysis compared the efficacy of 2-drug regimens with that of 3-drug regimens in bacteriological responses, acquired macrolide resistance (AMR), and mortality among adult patients with disseminated MAC infection (DMAC) and MAC pulmonary disease (MAC-PD). Results: Seven randomized controlled trials (RCTs) and 3 non-RCT studies, encompassing 1369 patients, were included. Treating DMAC with 2-drug regimens was associated with comparable bacteriological responses (odds ratio (OR) = 0.76, 95 % confidence interval (CI) = 0.48–1.18, P = .22) and mortality (OR = 1.29, 95 % CI = 0.59–2.83, P = .52), but had a higher risk of AMR (OR = 2.99, 95 % CI = 1.10–8.13, P = .03). For MAC-PD, 2-drug regimens were noninferior to 3-drug regimens in bacteriological responses (OR = 0.82, 95 % CI = 0.53–1.25, P = .35) and AMR (risk differences (RD) = 0.01, −0.02 to 0.05, P = .39), with no observed mortalities. Although not statistically significant compared to the 3-drug regimen, the macrolide–rifamycin regimen resulted in attenuated bacteriological responses (OR = 0.51, 95 % CI = 0.14–1.90, P = .32). However, the proportion of patients with bacteriological response (OR = 1.54, 95 % CI = 0.78–2.93, P = .23) and AMR risk (RD = 0.01, −0.02 to 0.04, P = .50) was not different between those under the macrolide-ethambutol regimen and those under 3-drug regimens. Conclusions: The macrolide–ethambutol 2-drug regimen may be a viable alternative option for treating MAC-PD, whereas DMAC can be preferably managed with a 3-drug regimen.http://www.sciencedirect.com/science/article/pii/S1876034125000607Mycobacterium avium complexMacrolideTreatment2-drug regimen3-drug regimen |
| spellingShingle | Van-Dong Nguyen Hai Duong Ming-Chia Lee Jin-Hua Chen Wei-Chang Huang Hsiao-En Chen Jung-Chun Lin Jann-Yuan Wang Chih-Hsin Lee Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysis Journal of Infection and Public Health Mycobacterium avium complex Macrolide Treatment 2-drug regimen 3-drug regimen |
| title | Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysis |
| title_full | Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysis |
| title_fullStr | Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysis |
| title_full_unstemmed | Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysis |
| title_short | Two-drug versus three-drug regimens for treating Mycobacterium avium complex infection: A systematic review and meta-analysis |
| title_sort | two drug versus three drug regimens for treating mycobacterium avium complex infection a systematic review and meta analysis |
| topic | Mycobacterium avium complex Macrolide Treatment 2-drug regimen 3-drug regimen |
| url | http://www.sciencedirect.com/science/article/pii/S1876034125000607 |
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