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Clinical Pharmacokinetic and Pharmacodynamic Considerations in the Drug Treatment of Non-Tuberculous Mycobacteria in Cystic Fibrosis

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Abstract

Non-tuberculous mycobacteria (NTM) are an emerging group of pulmonary infectious pathogens of increasing importance to the management of patients with cystic fibrosis (CF). NTM include slow-growing mycobacteria such as Mycobacterium avium complex (MAC) and rapidly growing mycobacteria such as Mycobacterium abscessus. The incidence of NTM in the CF population is increasing and infection contributes to significant morbidity to the patient and costs to the health system. Treating M. abscessus requires the combination of multiple costly antibiotics for months, with potentially significant toxicity associated with treatment. Although international guidelines for the treatment of NTM infection in CF are available, there are a lack of robust pharmacokinetic studies in CF patients to inform dosing and drug choice. This paper aims to outline the pharmacokinetic and pharmacodynamic factors informing the optimal treatment of NTM infections in CF.

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Acknowledgements

Jason A. Roberts would like to acknowledge funding from the Australian National Health and Medical Research Council for a Centre of Research Excellence (APP1099452) and a Practitioner Fellowship (APP1117065).

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Authors and Affiliations

  1. Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia

    Andrew Burke, Daniel Smith, Chris Coulter, Scott C. Bell & Rachel Thomson

  2. Faculty of Medicine, The University of Queensland School of Medicine, Brisbane, QLD, Australia

    Andrew Burke, Daniel Smith, Chris Coulter, Scott C. Bell & Rachel Thomson

  3. QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

    Scott C. Bell

  4. Immunology Department, Gallipoli Medical Research Institute, Brisbane, QLD, Australia

    Rachel Thomson

  5. Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia

    Jason A. Roberts

  6. Department of Pharmacy, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Jason A. Roberts

  7. Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Jason A. Roberts

  8. Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France

    Jason A. Roberts

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AB–conception of paper, extraction of data, interpretation of data, initial drafting of paper, review of paper and approval of final version of paper. DS–conception of paper, interpretation of data, review of paper and approval of final version of paper. CC– conception of paper, interpretation of data, review of paper and approval of final version of paper. SB–conception of paper, interpretation of data, review of paper and approval of final version of paper. RT–conception of paper, interpretation of data, review of paper and approval of final version of paper. JR–conception of paper, interpretation of data, initial drafting of paper, review of paper and approval of final version of paper.

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Andrew Burke, Daniel Smith, Chris Coulter, Scott C. Bell, Rachel Thomson and Jason A. Roberts have no actual conflicts of interest with this work.

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Burke, A., Smith, D., Coulter, C. et al. Clinical Pharmacokinetic and Pharmacodynamic Considerations in the Drug Treatment of Non-Tuberculous Mycobacteria in Cystic Fibrosis. Clin Pharmacokinet 60, 1081–1102 (2021). https://doi.org/10.1007/s40262-021-01010-4

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