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Compassionate Nitric Oxide Adjuvant Treatment of Persistent Mycobacterium Infection in Cystic Fibrosis Patients

Yaacoby-Bianu, Karin MD1,*; Gur, Michal MD1,*; Toukan, Yazeed MD1,2; Nir, Vered MD1; Hakim, Fahed MD1,2; Geffen, Yuval3; Bentur, Lea MD1,2

The Pediatric Infectious Disease Journal: September 6, 2017 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/INF.0000000000001780
Antimicrobial Reports: PDF Only

Background: Mycobacterium abscessus is one of the most antibiotic-resistant pathogens in Cystic Fibrosis (CF) patients. Nitric Oxide (NO) has broad-spectrum antimicrobial activity. Clinical studies indicated that it is safe and tolerable when given as 160 ppm intermittent inhalations.

Methods: A prospective compassionate adjunctive inhaled NO therapy in two CF patients with persistent Mycobacterium abscessus infection.

Results: No adverse events were reported. Both subjects showed significant reduction in quantitative PCR results for Mycobacterium abscessus load in sputum during treatment; estimated colony forming unit (CFU) decreased from 7000 to 550 and from 3000 to 0 for patient 1 and patient 2, respectively.

Conclusions: Intermittent inhalations with 160 ppm NO are well tolerated, safe and result in significant reduction of Mycobacterium abscessus load. It may constitute an adjuvant therapeutic approach for CF patients with Mycobacterium abscessus lung disease. Further studies are needed to define dosing, duration and long-term clinical outcome.

[1] Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel

[2] Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel

[3] Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel

* Karin Yaacoby-Bianu and Michal Gur have contributed equally to this work.

Contributions to the study: Lea Bentur: design, data collection, analysis, writing.

Karin Yaacoby-Bianu and Michal Gur: data collection, writing.

Yazeed Toukan, Vered Nir, Fahed Hakim: data collection and manuscript editing.

Yuval Geffen: bacteriologic analysis and manuscript editing.

Disclaimer: AIT Ltd supplied the device for the NO treatment and the technical support. AIT was not involved in the study design and its performance; they provided no financial support.

Corresponding author: Prof. Lea Bentur, Head, Pediatric Pulmonary Institute and CF Center, Ruth Rapport Children’s Hospital, Rambam Health Care Campus, P.O. Box 9602, Haifa 31096, Israel. Tel: +972-4-7774360, Fax: +972-4-7774395, E-mail: l_bentur@rambam.health.gov.il

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