Prophylaxis and Treatment of NTM Disease ATS-IDSA standard of care for NTM
From the American Thoracic Society website:
Prophylaxis and Treatment of NTM Disease
1. Treatment of MAC pulmonary disease. For most patients with nodular/bronchiectatic disease, a three-times-weekly regimen of clarithromycin (1,000 mg) or azithromycin (500 mg), rifampin (600 mg), and ethambutol (25 mg/kg) is recommended. For patients with fibrocavitary MAC lung disease or severe nodular/bronchiectatic disease, a daily regimen of clarithromycin (500–1,000 mg) or azithromycin (250 mg), rifampin (600 mg) or rifabutin (150–300 mg), and ethambutol (15 mg/kg) with consideration of threetimes-weekly amikacin or streptomycin early in therapy is recommended. Patients should be treated until culture negative on therapy for 1 year.
2. Treatment of disseminated MAC disease. Therapy should include clarithromycin (1,000 mg/d) or azithromycin (250 mg/d) and ethambutol (15 mg/kg/d) with or without rifabutin (150–350 mg/d). Therapy can be discontinued with resolution of symptoms and reconstitution of cellmediated immune function.
5. Treatment of M. abscessus pulmonary disease. There are no drug regimens of proven or predictable efficacy for treatment of M. abscessus lung disease. Multidrug regimens that include clarithromycin 1,000 mg/day may cause symptomatic improvement and disease regression. Surgical resection of localized disease combined with multidrug clarithromycin-based therapy offers the best chance for cure of this disease