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Suggest treatment for mycobacterium avium lung infection

Answered by
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Dr. Rovena Murati

General & Family Physician

Practicing since :2013

Answered : 1243 Questions

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Posted on Mon, 18 Aug 2014 in General Health
Question: my husband as MAI what treatment can he have
doctor
Answered by Dr. Rovena Murati 1 hour later
Brief Answer:
He may need 2-3 antibiotics for 12 months.

Detailed Answer:
Hello!
Welcome to Healthcare Magic!

You are saying that your husband has a lung infection caused by Mycobacterium Avium.

This mycobacterium is resistant to many antibiotics and antituberculosis drugs but is fairly susceptible to the following agents:
-Macrolides (eg, clarithromycin, azithromycin)
-Rifamycins (eg, rifampin, rifabutin)
-Ethambutol
-Clofazimine
-Fluoroquinolones (eg, ciprofloxacin, levofloxacin, moxifloxacin)
-Aminoglycosides (eg, amikacin, streptomycin)

In general, MA infection is treated with 2 or 3 antimicrobials for at least 12 months.
Commonly used first-line drugs include macrolides (clarithromycin or azithromycin), ethambutol, and rifamycins (rifampin, rifabutin).
Aminoglycosides, such as streptomycin and amikacin, are also used as additional agents.

His treating doctor (a lung specialist) will chose the best option for him.

Hope it was of help.
Let me know if you have any additional questions or doubt to clarify.I will be happy to assist you further.

Regards!

Dr.Rovena Murati
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rovena Murati 22 hours later
My husband as not seen the lung consultant yet,he his really out off breath using the neb 4 times a day,he cant have penicillin only colfosfloxi,no one really cares,no appointment until aug,i was in hospital over the weekend & his consultant said theres no treatment for him
doctor
Answered by Dr. Rovena Murati 2 hours later
Brief Answer:
He need to start the treatment.

Detailed Answer:
Hello again !
Hope you are doing well.

If your husband's sputum has come out positive for Mucobacterium Avium ,then he should start the treatment with antibiotics immediately.
There is no valuable reason to delay the treatment.
Since he is having difficulty breathing and his infection symptoms (cough with brown sputum) are getting worse you should insist with his treating doctor to evaluate his condition and start the treatment.

For mycobacterium avium infection first line of therapy are Macrolides (Clarithromycin or Azithromycin ) ,Ethambutol and Rifamycines .
So the fact that he has allergy to Penicillin isn't a problem for the treatment.

Hope it helps.
All the best!

Dr.Rovena Murati
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rovena Murati 17 hours later
yes his sputum test are positive,and brown sputum all the time,they have been sent to cardiff
I am not happy at all,this as beening going on now since last November when he had a bleed they said then he had bugs in his lungs but no treatment,plus he had pumonina 2010 in hospital for 5 weeks,then he got mrsa in the lungs,plus he now as bronostits
Sorry he as so gets air locks in the lungs aswell,plus his feet & legs swell up is this all to the infection
So you are telling me there is treatment then I have the lung consltultant saying there is no treatment,they said they are still wating for the results to come back from Cardiff to see how bad it is.all he does his cough up brown sputum & breathless I do all I can for my husband,his sats are 91.what else can I do,i phoned the hospital yesterday but no appointments until aug to me its wrong,
Will my husband have to go in to hospital for his treatment first,to find out which antibiotic he can have.in the end I would phone 999,but my husband does,nt want that,his inhalalers are not working he,s on vetolin & seridide,he told then this in XXXXXXX
doctor
Answered by Dr. Rovena Murati 5 hours later
Brief Answer:
Detailed below.

Detailed Answer:
Hello again!
I am sorry for all this situation you are facing.

Probably his doctors are waiting the confirmation for Mycobacterium Avium infection and a culture is done to see to which antibiotics the bacterium is sensitive to, so they can give him the right antibiotics.
The problem is that MA germs grow slowly, it may take up to 8 weeks to get the results.
So since your husband has chronic obstruction pulmonary disease (COPD) and his situation is not good at all , the treatment should not be delayed.
They may decide to start an empiric treatment until the test results come back.
This is a decision that his treating doctor (a lung specialist ) should made after evaluating his condition.

Definitely if he has Mycobacterium Avium infection there is a treatment for sure.
Probably they are waiting the confirmation from Cardiff to start the right antibiotics.I don't understand why his doctors said there is no treatment for this infection.

Relating the other question:feet,leg swelling.It is not due to infection himself ,but it is due to COPD.
Because COPD makes the heart work harder (particularly the right side, which pumps blood into the lungs), that side of the heart may enlarge. As the blood pressure in the lungs rises, the right ventricle contracts less efficiently.This is called cor pulmonale and it is a type of heart failure causing swelling of the legs ,ankles and feet.
He may need an evaluation of his heart.

For most COPD patients it should be aiming for an SaO2 of 88-92%.So a SaO2 of 91% is not so bad.
When the oxygen saturation drops to 88% or below, supplemental oxygen is usually prescribed.

If he has severe difficulty breathing and his inhalers are not working ,you should seek medical help.


Hope it help.
Let me know if I can help you further.

Regards!

Dr.Rovena Murati

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rovena Murati 22 hours later
What is Empiric treatment,
doctor
Answered by Dr. Rovena Murati 51 minutes later
Brief Answer:
To start antibiotics before culture results.

Detailed Answer:
Hello!
Hope you are doing well.

Empiric treatment refers to starting the treatment with antibiotics before doing the culture of the sputum to know for sure if the bacterium is sensitive to that antibiotic.
In your husband's case it refers to the fact that since his condition is getting worse the doctors may chose not to wait the result of the culture but start the treatment with antibiotics supposing to be effective against the bacterium.
When the result of the culture come and the bacterium is resistant to the antibiotic we start then , the therapy is changed.

The empiric therapy is started when the condition is getting worse and the patient situation is critical.

If his doctors think that a delay in treatment won't aggravate his condition, they can chose to wait until the culture result come back to start a treatment.

Wish you all the best!
Dr.Rovena Murati
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rovena Murati 23 hours later
The sputum was sent on the 5th XXXXXXX 2014
doctor
Answered by Dr. Rovena Murati 2 hours later
Brief Answer:
The result will be available soon.

Detailed Answer:
Hello again!

Because Mycobacterium avium grows very slowly in culture ,it may take 6-8 weeks to have the result of sputum culture.

Since the sputum was sent on the 5th XXXXXXX ,it may take only some more days for the result to come back.
In this case it is better to wait for the result before start the treatment.

Wish you all the best!
Take care!

Dr.Rovena Murati
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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