Table 3.
Shows recommended susceptibility testing and active therapeutic agents used in the treatment of slowly growing NTM isolates.
| Organism | Recommended susceptibility testing | Effective therapeutic agents | ||||
|---|---|---|---|---|---|---|
| M. kansasii | **Rifampin susceptibility should be performed for all new/untreated M. kasasii isolates | **Combination therapy: daily or three times per week | ||||
| ***In case of rifampin resistance | - Rifampin/rifabutin | - Isoniazid - Ethanbutol | ||||
| **Quinolones | **In case of Rifampin resistance | |||||
| **Clarithromycin | **INH | **Streptomycin | A- Macrolide + quinolone based therapy: clarithromycin/azithromycin, moxiflxacin, linezolid | |||
| **Sulfamethoxazole | **Ethambutol | **Amikacin | B- High-dose isoniazid +1 or 2 other agents: Quinolone, macrolide, aminoglycoside, TMP/SMZ or linezolid | |||
| MAC | *Routine susceptibility testing is not performed in most laboratories except in case of clarithromycin resistance | **Limited disease: azithromycin/clarithromycin + rifampin/rifabutin+ethambutol | ||||
| **Clarithromycin | **Rifabutin | **Extensive/cavitary disease: above regimen+aminoglycoside: streptomycin/amikacin | ||||
| **Quinolones | **Ethambutol | **Macrolide resistance: isoniazid, rifabutin, ethambutol, macrolide, linezolid, streptomycin/amikacin | ||||
| M. szulgai | **INH | **Aminoglycosides | **Isoniazid, rifampin, ethambutol ? 4th drug such as pyrazinamide | |||
| **Rifampin | **Quinolones | |||||
| **Ethambutol | **Macrolides | |||||
| M. xenopi | **INH | **Isoniazid, rifampin/rifabutin ? streptomycin | ||||
| **Rifampin | **Quinolones | **Clarithromycin + rifampin + ethambutol | ||||
| **Ethambutol | **Macrolides | **Other active agents: clarithromyci/azithromycin, amikacin, moxifloxacin | ||||
| M. malmoense | **INH | **Isoniazid, rifampin + ethambutol ? macrolide and/ or quinolone | ||||
| **Ethambutol | **Quinolones | |||||
| **Rifampin | **Macrolides | |||||
| M. marinum | *M. marinum isolates do not require susceptibility testing unless therapy fails for several months | **Clarithromycin or azithromycin + ethambutol | ||||
| **Doxycycline | **Ethambutol | **Surgical debridement | **Rifampin in case of osteomyelitis | |||
| **Rifampin | **Sulfonamides | **Other active agents: ethambutol, TMP/SMZ, rifampin, rifabutin, ciprofloxacin, moxifloxacin, amikacin, doxycycline | ||||
| M. haemophilum | **Aminoglycosides: streptomycin/amikacin | **At least three drugs | **Variable duration: 3–42 months | |||
| **Quinolones: ciprofloxacin | **Active drugs: amikacin, rifampin, rifabutin, ethambutol, clarithromycin, ciproflxacin | |||||
| **Macrolides: clarithromycin | ||||||
| M. ulcerans | *Medical therapy has not been shown to be beneficial | **Rifampin | **Moxifloxacin | |||
| **Dapsone | **Diarylquinolone R 207910 | |||||
| *Surgical Rx with skin grafting are vital | **Streptomycin | **Nitroimidazopyran PA-824 | ||||
| *Combinations of in vitro active agents may be beneficial | **Amikacin | **Linezolid | ||||