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Management of nontuberculous mycobacterial pulmonary disease

Adelman, Mark, H.; Addrizzo-Harris, Doreen, J.

Current Opinion in Pulmonary Medicine: May 2018 - Volume 24 - Issue 3 - p 212–219
doi: 10.1097/MCP.0000000000000473
INFECTIOUS DISEASES: Edited by Alimuddin Zumla and Michael S. Niederman

Purpose of review To highlight recent original research and specialty society guidelines regarding the diagnosis and treatment of nontuberculous mycobacterial (NTM) pulmonary disease.

Recent findings The prevalence of NTM pulmonary disease has risen in recent years. The prevalence of individual NTM species varies geographically, although Mycobacterium avium complex (MAC) and Mycobacterium abscessus complex (MABC) remain among the most commonly encountered in many regions. Diagnosis and treatment of NTM pulmonary disease can be complex but guideline-based recommendations have been published. However, adherence to guideline recommendations is poor. Drug susceptibility testing plays a role with important caveats for treatment. Alternative therapies are being explored with older antimycobacterial drugs like clofazimine, which has demonstrated efficacy and tolerability for treatment-refractory NTM infections, and a novel formulation of amikacin for inhalation which may be better tolerated than parenteral administration. Several studies have shown that patients will have recurrences as high as 48%, and that these are not solely relapses but many cases are reinfections with a new organism. United States and European research registries of patients with non-cystic fibrosis bronchiectasis are expected to provide needed data on clinical characteristics of patients at risk for NTM pulmonary disease.

Summary The evidence base for optimal management of NTM pulmonary disease is expanding but notable gaps in the literature remain.

New York University School of Medicine, New York, NY, USA

Correspondence to Doreen J. Addrizzo-Harris, 530 First Avenue, Suite 5D, New York, NY 10016, USA. Tel: +1 212 263 6479; fax: +1 212 263 8442; e-mail: doreen.addrizzo@nyumc.org

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