[The effect of the regimen containing cefoxitin on highly drug-resistant rapidly growing nontuberculous mycobacterial pulmonary disease].

OBJECTIVE: To evaluate the therapeutic effect and safety of the regimen containing cefoxitin on highly drug-resistant rapidly growing nontuberculous mycobacterial (RGM) pulmonary disease.

METHODS: From January to December 2007, 16 patients with RGM pulmonary disease, who had been treated for 6-48 months, average (15 ± 11) months but still sputum positive, were included in the study and treated with a new regimen containing cefoxitin, fluoroquinolone, macrolide, and SMZco. Cefoxitin was used in the first 3 months and the total duration of therapy was 18 months. Sputum conversion rate, radiology change and side effects were observed before and after the therapy.

RESULTS: Underlying chronic diseases including COPD (n = 2), tuberculosis (n = 3), bone-marrow transplantation due to chronic leukemia (n = 1) and bronchiectasis (n = 5), were present in 11 patients. Main symptoms before therapy were cough and expectoration. There were multi-focal patchy, small nodular shadows with cavities on CT scans. The 16 clinical strains were highly resistant to anti-tuberculous drugs: 15/16 to streptomycin, 16/16 to isoniazid, 14/16 to rifampin, 13/16 to ethambutol, 14/15 to amikacin, 15/15 to capreomycin and 14/15 to ofloxacin. After treatment, the clinical symptoms improved in all patients. Eight of the 16 patients became sputum negative by 6 months which lasted to the end of the therapy, while another 8 patients remained sputum positive. Six patients showed radiological improvement. No one experienced side effects induced by cefoxitin. The total cure rate was 8/16.

CONCLUSION: The regimen containing cefoxitin has certain effect on highly drug-resistant nontuberculous mycobacterial pulmonary disease, especially for RGM.