背景：非结核分枝杆菌是引起感染的环境生物，导致慢性，使人衰弱的肺部疾病，其中鸟分枝杆菌复合体（MAC）是最常见的物种。
方法：我们描述了2006年1月至2014年12月期间，美国医疗保险患者支气管扩张患者中基于大环内酯的多药抗生素治疗MAC肺病(MAC-PD)的模式。MAC治疗被定义为包含大环内酯和≥1种其他靶向MAC-PD的药物的多药方案（利福霉素，乙胺丁醇,氟喹诺酮,或阿米卡星）同时处方>28天。
结果：我们确定了9189个新的MAC治疗使用者，治疗开始时的平均年龄（标准差）为74（6岁）;75％的女性和87％的非西班牙裔白人。基于指南的方案(大环内酯，乙胺丁醇,和利福霉素,在治疗开始时，有或没有阿米卡星）为51％的新MAC疗法使用者开了处方，其中41%的人在6个月时继续进行基于指南的治疗，12个月时只有18%。在所有新的MAC治疗用户中，到18个月，只有11%的人仍在接受MAC治疗，55%的人停止了治疗，34%因死亡或研究期结束而被审查.
结论：总体而言，近一半的新MAC治疗使用者接受了非指南推荐的基于大环内酯的治疗,包括通常与促进大环内酯耐药性相关的方案。治疗中断很常见，一旦停产，只有少数受益人在稍后的时间恢复治疗。我们的研究为当前有关美国老年人群MAC-PD治疗模式的文献增加了重要数据。未来的研究应该使用更多的当代数据源来检查治疗模式。
Nontuberculous mycobacteria are environmental organisms that cause infections leading to chronic, debilitating pulmonary disease, among which Mycobacterium avium complex (MAC) is the most common species.
We described patterns of macrolide-based multidrug antibiotic therapies for MAC pulmonary disease (MAC-PD) in US Medicare beneficiaries with bronchiectasis between January 2006 and December 2014. MAC therapy was defined as a multidrug regimen containing a macrolide plus ≥1 other drug targeting MAC-PD (rifamycin, ethambutol, fluoroquinolone, or amikacin) prescribed concomitantly for >28 days.
We identified 9189 new MAC therapy users, with a mean age (standard deviation) of 74 (6 years) at the start of therapy; 75% female and 87% non-Hispanic white. A
guideline-based regimen (a macrolide, ethambutol, and rifamycin, with or without amikacin) was prescribed for 51% of new MAC therapy users at treatment start, of whom 41% were continuing
guideline-based therapy at 6 months, and only 18% at 12 months. Of all new MAC therapy users, by 18 months only 11% were still receiving MAC treatment, 55% had discontinued therapy, and 34% were censored owing to death or the end of the study period.
Overall, nearly half of new MAC therapy users were prescribed a non-
guideline-recommended macrolide-based therapy, including regimens commonly associated with promoting macrolide resistance. Treatment discontinuation was common, and once discontinued, only a few beneficiaries resumed therapy at a later time. Our study adds important data to the current literature on treatment patterns for MAC-PD among older US populations. Future research should examine treatment patterns using more contemporary data sources.
