Table 2.
Recommended treatment regimen.
| Type of Disease | Recommend Regimen | |
|---|---|---|
| Mycobacterium avium Disease | Pulmonary MAC Infections | macrolides, followed by close follow-up monitoring for up to a year |
| Mild or moderate bronchiectatic disease | azithromycin (500 mg three times per week), rifampin (600 mg three times per week), and ethambutol (25 mg/kg three times per week) | |
| Cavitary or severe nodular bronchiectatic disease | a daily regimen of azithromycin (250 to 500 mg daily), rifampin (600 mg daily), and ethambutol (15 mg/kg daily) and a fourth agent consisting of parenteral streptomycin or amikacin (10 to 15 mg/kg three times per week) is used for the first 8 to 12 weeks of therapy | |
| Macrolide resistant infections | daily ethambutol, rifampin, and clofazimine, in addition to two to three months of parenteral amikacin administered three times a week | |
| Disseminated MAC infections with AIDS | combination of antimicrobial and antiretroviral therapy (ART) and may take more than 12 months; dual therapy with a macrolide, azithromycin (500–600 mg daily), or clarithromycin (500 mg twice daily), combined with ethambutol (15 mg/kg daily) is initially used |
|
| Disseminated MAC infections with AIDS failing ART | dual therapy with a macrolide, azithromycin (500–600 mg daily), or clarithromycin (500 mg twice daily), combined with ethambutol (15 mg/kg daily) is initially used, plus a third agent (e.g., rifabutin) is added | |
| MAC Lymphadenitis | surgical excision and/or antimicrobial therapy; antimicrobial therapy includes a macrolide in combination with ethambutol and/or rifampin; Azithromycin is the preferable macrolide for children; the duration for antimicrobial therapy of NTM or MAC specific lymphadenitis may take up to six months |
|
| Mycobacterium abscessus Diseases | M. abscessus complex-associated pulmonary disease | combination of macrolide-based therapy with intravenous antimicrobial agents; surgical resection of the localized infection in combination with antimicrobial therapy; continue until sputum samples are negative for M. abscessus complex for 12 months |
| M. abscessus complex-associated skin and soft tissue infections (SSTIs) | macrolide in combination with amikacin plus cefoxitin/imipenem plus surgical debridement; minimum of 4 months, including a minimum of 2 weeks combined with intravenous agents | |
| M. abscessus-associated central nervous system infections: cerebral abscesses and meningitis | treatment includes at least one year of clarithromycin-based combination therapy (preferably including at least amikacin in the first weeks) for 12 months and surgical intervention if needed | |
| M. abscessus complex ocular infections | systemic antimicrobial drugs can be used to treat most M. abscessus-associated ocular infections, while topical therapy with topical amikacin and clarithromycin are used to treat certain M. abscessus complex ocular infections for 6weeks to 6 months | |
| Serious M. abscessus complex infections | initial treatment should include a combination of antimicrobial drugs with a macrolide (clarithromycin with 1,000 mg daily or azithromycin with 250 mg to 500 mg daily) and intravenous agents for two weeks to several months subsequently after oral macrolide-based therapy. The initial intravenous drug treatment is amikacin for (25 mg/kg 3×/week) and cefoxitin (up to 12 g/d in divided doses) or amikacin (25 mg/kg 3×/week) and imipenem (500 mg 2–4×/week) |