From the Guidelines
The recommended treatment for non-tuberculous mycobacterium (NTM) infections typically involves a multidrug regimen tailored to the specific NTM species and infection site, with treatment duration and intensity guided by disease severity, patient response, and drug susceptibility testing, as outlined in the US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations 1.
Key Considerations for NTM Treatment
- For Mycobacterium avium complex (MAC), treatment usually consists of a macrolide (clarithromycin 500mg twice daily or azithromycin 500mg daily), ethambutol (15mg/kg daily), and rifampin (600mg daily) or rifabutin (300mg daily) 1.
- For M. abscessus, treatment is more challenging and often includes combinations of macrolides, amikacin, imipenem, tigecycline, and/or cefoxitin, frequently requiring both intravenous and oral phases 1.
- Treatment success depends on the NTM species, disease extent, underlying conditions, and medication tolerability, with regular monitoring for drug toxicities essential, including audiometry for aminoglycosides, liver function tests for rifamycins, and visual acuity testing for ethambutol 1.
Treatment Duration and Monitoring
- Treatment duration typically ranges from 18-24 months total for pulmonary disease, with the goal of achieving culture conversion and clinical improvement 1.
- Regular monitoring of sputum cultures, every 4-8 weeks, is necessary to assess the microbiological response to treatment, and to adjust the treatment regimen as needed 1.
- An HRCT scan of the lungs should be performed shortly before starting NTM treatment and at the end of NTM treatment to assess the radiological response 1.
Special Considerations
- Individuals with CF receiving NTM treatment should be managed in collaboration with experts in the treatment of NTM and CF, due to the complexity of these cases and the potential for drug intolerance and toxicity 1.
- Monotherapy with a macrolide or other antimicrobial agent should never be used in the treatment of NTM infections, as this can lead to resistance and treatment failure 1.
- Surgical intervention may be necessary for localized disease or when medical therapy fails, and should be considered in consultation with experts in the treatment of NTM and CF 1.
From the Research
Treatment Options for Non-Tuberculoid Mycobacterium (NTM) Infections
- The treatment of NTM infections often involves a combination of antibiotics, with the specific regimen depending on the type of NTM and the site of infection 2, 3, 4.
- For pulmonary NTM infections, such as those caused by Mycobacterium avium complex (MAC), treatment regimens may include azithromycin, rifabutin, ethambutol, and streptomycin 2.
- For extrapulmonary NTM infections, such as skin and soft-tissue infections, musculoskeletal infections, and lymphadenitis, treatment regimens may include rifampicin, ethambutol, and clarithromycin 3, 4.
- The duration of treatment for NTM infections can vary, but is often prolonged, ranging from several months to a year or more 4.
Specific Treatment Regimens
- A study published in 2001 found that treatment regimens containing azithromycin were effective for treating MAC lung disease, with success rates ranging from 55% to 65% 2.
- A study published in 2021 found that a regimen of rifampicin, ethambutol, and clarithromycin was effective for treating tenosynovitis of the hand caused by MAC, with complete healing achieved in 5 of 7 patients 3.
- A study published in 1996 found that a regimen of rifabutin, ethambutol, and clarithromycin was more effective than a regimen of rifampin, ethambutol, clofazimine, and ciprofloxacin for treating MAC bacteremia in patients with AIDS 5.