Mycobacteria species and patient characteristics | Suggested regimen | Comments |
Mycobacterium tuberculosis not yet excluded |
| - Isoniazid, plus
- Rifampin (rifampicin), plus
- Ethambutol, plus
- Azithromycin (preferred*) or clarithromycin, plus
- Pyrazinamide¶
| - Provides empiric coverage for M. tuberculosis and two NTM species commonly isolated from children with NTM pulmonary disease (MAC and Mycobacterium kansasii)
- Modify regimen when NTM species is identified and speciation M. tuberculosis is confirmed or excluded
|
MAC infection |
HIV-negative, with nodular or noncavitating disease | - A rifamycin (rifampin [rifampicin] or rifabutin), plus
- Ethambutol, plus
- Azithromycin (preferred*) or clarithromycin
| - Administer regimen 3 times per week
- Continue until sputum cultures negative for ≥1 year
|
HIV-negative, with fibrocavitary disease or extensive bronchiectasis | - A rifamycin (rifampin [rifampicin] or rifabutin), plus
- Ethambutol, plus
- Azithromycin (preferred*) or clarithromycin, plus
- An aminoglycoside (amikacin or streptomycin)
| - Administer rifamycin, ethambutol, and macrolide daily
- Aminoglycoside:
- For children: Administer daily
- For adolescents: Amikacin may be administered 3 times per week
- Discontinue aminoglycoside after 8 weeks
- Continue other agents until sputum cultures negative for ≥1 year
|
HIV-positive | - Treat as for children with disseminated NTM infection
| - Refer to UpToDate content on disseminated NTM infection
|
Mycobacterium abscessus infection |
| - Azithromycin (preferred*) or clarithromycin, plus
- Amikacin, plus
- Cefoxitin or a carbapenem (eg, imipenem, meropenem)
- For M. abscessus subspecies abscessus or M. abscessus subspecies bolletii, add another drug (eg, linezolid, tigecycline)Δ
| - Select drugs based on susceptibility testing
- Use at least 3 active drugs initially; may narrow to 2 drugs after 4 to 8 weeks
- Continue until there is symptomatic and radiographic improvement
|
Mycobacterium kansasii infection |
Rifampin-susceptible | - Rifampin (rifampicin), plus
- Ethambutol, plus
- Either a macrolide (azithromycin [preferred*] or clarithromycin) or isoniazid◊
| - Continue until sputum cultures negative for ≥1 year
|
Rifampin-resistant or intolerance to a first-line medication | - Treat with 3 drugs based upon in vitro susceptibilities
- Options include macrolides, fluoroquinolones, aminoglycosides, and trimethoprim-sulfamethoxazole
| - Continue until sputum cultures negative for 12 to 18 months
|