Adverse reactions in the treatment of patients with non-tuberculous pulmonary mycobacteriosis

<b>Aim:</b> To determine the frequency and the nature of adverse reactions (AR) in the combination antibiotic therapy of patients with diagnosed nontuberculous pulmonary mycobacteriosis (NTPM) and comorbidities. <b>Methods:</b> At Central TB Research Institute 112 patients with NTPM diagnosed according to the ATS recommendations received treatment with three antibiotics. Comorbidities were established in 73.7% of the patients, including bronchiectatic disease – 70%, COPD – 17%, bronchial asthma – 4%, hypertension – 20%, gastrointestinal disease – 15%, renal lesions – 3%, and endocrinopathy – 10% of the patients. <b>Results:</b> We observed AR in 33% of the patients. Administration of rifabutin (Rb) induced 46%, protionamide (Pt) – 42%, isoniazid (H) – 31% of AR; macrolides (M), fluoroquinolones (Fq), aminoglycosides (Am), rifampicin (R), and pyrazinamide (Z) induced 20-23% of AR. Toxicoallergic reactions accounted for 34%, gastrointestinal disorders – 28% at administration of Pt, R, M; drug-induced hepatitis – 17% at administration of Rb, R, Fq; cardiotoxic effects – 12% at administration of Pt, M, Fq; ototoxicity – 11% at administration of Am injections, and optic neuritis – 5% at administration of ethambutol. Therapy correction was required in 30.6% of the patients; therapy was cancelled in 13.5% due to severe AR. <b>Conclusion:</b> NTPM treatment is hampered due to natural resistance of nontuberculous mycobacteria, high risk of AR, summation of AR at administration of several antibiotics, and comorbidities. The choice of antibiotics should consider their potential intolerance. Development of AR requires assessment of their degree and reversibility and the decision on the treatment correction or cancellation.