Adverse reactions in the treatment of patients with non-tuberculous lung mycobacterial pulmonary disease and the possibility of their solution

Aim. To study the adverse reactions that develop as a result of complex antibiotic therapy in patients with non-tuberculous lung mycobacterial (NTML) and to determine methods for their elimination without compromising the effectiveness of NTML treatment.

Materials and methods. Examined 147 patients with confirmed NTML, for which they received treatment in accordance with the results of drug susceptibility of the pathogen. Before and during treatment, a study of clinical, biochemical blood tests, urinalysis, electrocardiogram, external respiration function, ultrasound of the abdominal organs and kidneys was performed.

Results. Under the conditions of antimicrobial therapy (AMT) for non-tuberculous mycobacteriosis of the lungs, 41 (27.9%) patients developed adverse drug reaction (ADR). The most frequent adverse reactions were: allergic reactions in the form of urticaria, nausea, vomiting, arthralgia, nephro- and ototoxic reactions; 34 (82.9%) patients required treatment adjustment without discontinuation of AMT, and only in 7 (17.1%) cases, AMT was discontinued. A full course of multicomponent AMT was completed in 124 (84.4%) patients with NTML. An algorithm for monitoring therapy in NTML patients from the standpoint of preventing ADR has been developed. The categories of patients with potential risks of developing ADR under AMT were determined. Patients without the development of ADR had a positive radiological dynamics in 27.9% of cases, sputum conversion – in 42%. Patients with ADR had positive clinical dynamics in 39% of cases, radiological – in 31.7% of cases, sputum conversion – in 36.6% of cases.

Conclusion. The incidence of ADR development remains high when complex AMT is administered to patients with NTML. The patient's comorbid background is the main risk factor for the development of ADR when prescribing multicomponent AMT. A multivariate analysis of the effectiveness of treatment in NTML patients showed comparable data among patients taking complex AMT and receiving only alternative therapies. The success of NTML treatment depends on a comprehensive personalized approach.