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

Yaacoby-Bianu, Karin, MD*; Gur, Michal, MD*; Toukan, Yazeed, MD*†; Nir, Vered, MD*; Hakim, Fahed, MD*†; Geffen, Yuval, PhD; Bentur, Lea, MD*†

The Pediatric Infectious Disease Journal: April 2018 - Volume 37 - Issue 4 - p 336–338
doi: 10.1097/INF.0000000000001780
Antimicrobial Reports
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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 2 CF patients with persistent Mycobacterium abscessus infection.

Results: No adverse events were reported. Both subjects showed significant reduction in quantitative polymerase chain reaction results for Mycobacterium abscessus load in sputum during treatment; estimated colony forming unit 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.

From the *Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel; and Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel.

Accepted for publication April 24, 2017.

K.Y.-B. and M.G. have contributed equally to this work.

L.B. contributed to design, data collection, analysis, writing. K.Y.-B. and M.G. contributed to data collection, writing. Y.T., V.N., F.H. contributed to data collection and manuscript editing. Y.G. contributed to bacteriologic analysis and manuscript editing.

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.

The authors have no conflicts of interest to disclose.

Address for correspondence: Lea Bentur, MD, Pediatric Pulmonary Institute and CF Center, Ruth Rapport Children’s Hospital, Rambam Health Care Campus, PO Box 9602, Haifa 31096, Israel. E-mail: l_bentur@rambam.health.gov.il.

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