Table 4.
Recommended Treatment Regimens for Mycobacterium avium complex, M. kansasii, and M. xenopi Pulmonary Disease
| Organism | No. of Drugs | Preferred Drug Regimena | Dosing Frequency |
|---|---|---|---|
| M. avium complex | |||
| Nodular-bronchiectatic | 3 | Azithromycin
(clarithromycin) Rifampicin (rifabutin) Ethambutol |
Three times weekly |
| Cavitary | ≥ 3 | Azithromycin
(clarithromycin) Rifampicin (rifabutin) Ethambutol Amikacin IV (streptomycin)b |
Daily (three times weekly may be used with aminoglycosides) |
| Refractoryc | ≥ 4 | Azithromycin
(clarithromycin) Rifampicin (rifabutin) Ethambutol Amikacin liposome inhalational suspension or Amikacin IV (streptomycin)b |
Daily (three times weekly may be used with aminoglycosides) |
| M. kansasii | |||
| 3 | Azithromycin
(clarithromycin) Rifampicin (rifabutin) Ethambutol |
Daily | |
| 3 | Azithromycin
(clarithromycin) Rifampicin (rifabutin) Ethambutol |
Three times weekly | |
| 3 | Isoniazid Rifampicin (rifabutin) Ethambutol |
Daily | |
| M. xenopi | |||
| ≥3 | Azithromycin (clarithromycin) and/or
moxifloxacin Rifampicin (rifabutin) Ethambutol Amikacinb |
Daily (three times weekly may be used with aminoglycosides) | |
See table 3 for recommended dosages. Alternative drugs for patients who are intolerant of or whose isolate is resistant to first-line drugs include clofazimine, moxifloxacin, and linezolid. Some experts would consider bedaquiline or tedizolid.
Consider for cavitary, extensive nodular bronchiectatic disease or macrolide resistant MAC. Amikacin or streptomycin may be given three times a week.
Refractory disease is defined as remaining sputum culture positive after six months of guideline-based therapy. Amikacin liposome inhalation suspension (ALIS) has been shown to improve culture conversion when added to guideline-based therapy in treatment refractory patients with MAC pulmonary disease.