How can my liver and bone health be maintained with MAC?

Question

Hello doctor,

I am a 58-year-old woman recently diagnosed with MAC (Mycobacterium avium complex) lung disease after months of persistent cough, fatigue, and unintentional weight loss of about 13 pounds.

My sputum culture was positive for MAC, and a high-resolution CT (computed tomography) scan shows nodular bronchiectasis predominantly in the right middle lobe and lingula. I have started triple therapy with Azithromycin, Ethambutol, and Rifampin, but I am experiencing significant gastrointestinal upset and blurred vision.

In addition, I have osteoporosis. My DEXA (dual energy X-ray absorptiometry) scan showed a T-score of -2.8 at the lumbar spine, and I am currently on Alendronate weekly along with calcium and vitamin D supplements (serum vitamin D was low at 16 ng/mL).

I also have mild COPD (chronic obstructive pulmonary disease) with an FEV1 (forced expiratory volume in one second) of 68 percent predicted and use a Tiotropium inhaler daily. My latest liver function tests showed elevated ALT (alanine transaminase) (72 U/L) and ALP (alkaline phosphatase) (130 U/L), and I am concerned about drug toxicity.

Is there an alternative treatment approach for MAC in patients with multiple comorbidities like mine?
How closely should my liver and bone health be monitored during therapy?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Let us look into it carefully. Your current treatment plan with triple drug therapy is the standard treatment for MAC (Mycobacterium Avium complex) and also appropriate for your CT (computed tomography) imaging findings. However, these drugs can cause adverse effects, especially in patients with conditions such as osteoporosis, COPD (chronic obstructive pulmonary disease), and liver disease.

Your symptoms may be side effects of these drugs. For example, Azithromycin and Rifampin can cause GI (gastrointestinal) upset. Blurred vision could be due to ethambutol-induced optic neuritis, and if so, it is alarming. You might have to discontinue Ethambutol immediately and consult your physician.

Also, Rifampin can cause hepatotoxicity, which might be the reason for elevated ALT (alanine transaminase) and ALP (alkaline phosphatase). I suggest monitoring your LFTs (liver function tests) every two weeks, and if values keep rising, consider adjusting the Rifampin dose or temporarily stopping it. Continue taking Alendronate, calcium, and Vitamin D supplements for osteoporosis.

For osteoporosis and COPD (chronic obstructive pulmonary disease), you can continue Tiotropium. Do not discontinue treatment abruptly because MAC can become chronic and drug-resistant. Kindly follow the above-mentioned advice under the supervision of your doctor.

Wishing you strength and a smooth recovery. Please feel free to share updated test reports or symptoms anytime.

I hope this answers your query. Let me know if I need to assist you further.