Medications and Monitoring in Treatment of Nontuberculous Mycobacterial Pulmonary Disease

Most patients who are treated for NTM-PD will experience a treatment related adverse event. Adverse effects are the most frequently cited reason for alteration of a regimen away from guideline-based therapy and inappropriate treatment regimens are a strong risk factor for macrolide resistance.46 When intolerances or adverse events occur, the patient and clinician must review the perceived risks of ongoing administration, weighed up against the likely benefit of continued treatment. There is often limited data to guide shared decision making. In an attempt to identify the causative agent of a non-severe side effect, stopping all medications followed by rechallenge in a staggered fashion is often necessary. An understanding of the common toxicity profiles of NTM antibiotics allows the prescriber to minimize risk, manage side effects as they arise, and increase the likelihood of successful treatment outcomes.