From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For suspected Mycobacterium intracellulare (M. intracellulare) pneumonia based on CT chest findings, further workup should include sputum cultures specifically for acid-fast bacilli (AFB), with at least three early morning samples collected on separate days, as recommended by the most recent and highest quality study 1.
Further Workup
- Sputum cultures for AFB with at least three early morning samples collected on separate days
- Bronchoscopy with bronchoalveolar lavage may be necessary if sputum samples cannot be obtained
- Blood cultures for mycobacteria and HIV testing are also recommended, as M. intracellulare infections are common in immunocompromised patients
Antibiotic Coverage
- Treatment typically requires a multidrug regimen consisting of a macrolide (clarithromycin 500mg twice daily or azithromycin 500mg daily), ethambutol (15mg/kg daily), and rifampin (600mg daily) 2, 3
- This three-drug combination should be continued for at least 12 months after culture conversion to negative
- In patients with severe disease or immunocompromise, adding amikacin or streptomycin during the initial phase may be beneficial
Monitoring and Treatment Success
- Regular monitoring for medication side effects is essential, including monthly visual acuity and color discrimination tests for ethambutol toxicity, and liver function tests for rifampin
- Treatment success requires adherence to this complex regimen for the full duration, with a focus on reducing morbidity, mortality, and improving quality of life 4