Management Of Pulmonary Nontuberculous Mycobacteria Disease

The treatment of disease caused by NTM is challenging, employing multidrug regimens for at least 1 year. Adverse events are not uncommon, and as some subjects may remain stable without treatment the decision on which patients to treat and at what point to begin treatment is of great importance. The choice of treatment regimen is determined primarily by the NTM species and disease severity. Drug sensitivity testing also plays an important role, but the interpretation is not straightforward. For slow-growing mycobacteria rifamycins, macrolides and ethambutol form the mainstay of treatment. Rapidly growing mycobacteria frequently display extensive drug resistance and may require a combination of parental and oral agents. Surgery should also be considered in selected cases. Outcomes vary widely between species, with an almost universal response to treatment seen in Mycobacterium kansasii whereas in Mycobacterium abscessus a cure may often not be attainable.