{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:45:48Z","timestamp":1792259148275,"version":"4.4.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Clin Microbiol Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Ethambutol is a key component of treatment for\n                      <jats:italic>Mycobacterium avium<\/jats:italic>\n                      complex pulmonary disease (MAC-PD), primarily through suppression of macrolide resistance. However, adverse drug reactions frequently lead to treatment interruption, and evidence-based alternatives remain limited. We evaluated the feasibility and outcomes of a structured outpatient ethambutol desensitisation protocol in patients with MAC-PD who developed ethambutol intolerance or hypersensitivity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicentre observational study across four specialist NTM centres. Patients undergoing treatment for MAC-PD who experienced an ethambutol-related adverse reaction leading to drug cessation were eligible. A patient-led outpatient desensitisation protocol commenced at 25\u00a0mg daily with gradual dose escalation to a weight-based target dose. The protocol allowed temporary dose reduction to previously tolerated levels if symptoms recurred. Success was defined as achievement of the target dose or maintenance of a tolerated dose associated with sustained culture conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty desensitisation episodes were performed in 17 patients (65% female; mean age 72 years). The most common indication was rash (70%), followed by headache (15%). Overall, 17\/20 (85%) desensitisations were successful, including 13\/14 (93%) among patients with delayed cutaneous reactions. Mean time to target dose was 9 weeks (median 4 weeks). No severe immediate hypersensitivity reactions occurred during desensitisation. Sixteen episodes (80%) were associated with culture conversion, and 11 (55%) patients completed therapy with ethambutol-containing regimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Outpatient ethambutol desensitisation appears feasible, safe and effective in selected patients with MAC-PD and non-severe ethambutol intolerance. This approach may help preserve an essential component of MAC therapy when treatment options are otherwise limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10096-026-05702-2","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:06:12Z","timestamp":1792224372000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Desensitisation protocol for ethambutol in the treatment of Mycobacterium avium complex pulmonary disease"],"prefix":"10.1007","author":[{"given":"George","family":"Denby","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Holt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Grey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Burke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Thomson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ieuan Edward Shepherd","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"issue":"3","key":"5702_CR1","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1128\/AAC.39.3.694","volume":"39","author":"L Deng","year":"1995","unstructured":"Deng L, Mikusova K, Robuck KG, Scherman M, Brennan PJ, McNeil MR (1995) Recognition of multiple effects of ethambutol on metabolism of mycobacterial cell envelope. 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Approval was granted by the Metro North Health Human Research Ethics Committee (HREC\/15\/QPCH\/65). Given the low-risk clinical nature of the data collected a waiver of consent was granted for this study.","order":1,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Clinical Trial Number","group":{"name":"EthicsHeading","label":"Declarations"}}]}}