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Treatment of Non-Tuberculous Mycobacterial Lung Disease

  • Mycobacterial Infections (H Bach, Section Editor)
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An Erratum to this article was published on 03 November 2016

Opinion statement

Treatment of non-tuberculous mycobacterial lung disease (NTM-LD) is challenging for several reasons including the relative resistance of NTM to currently available drugs and the difficulty in tolerating prolonged treatment with multiple drugs. Yet-to-be-done, large, multicenter, prospective randomized studies to establish the best regimens will also be arduous because multiple NTM species are known to cause human lung disease, differences in virulence and response to treatment between different species and strains within a species will make unbias randomization difficult, the need to distinguish relapse from a new infection, and the difficulty in adhering to the prescribed treatment due to intolerance, toxicity, and/or drug-drug interactions, often necessitating modification of therapeutic regimens. Furthermore, the out-of-state resident status of many patients seen at the relatively few centers that care for large number of NTM-LD patients pose logistical issues in monitoring response to treatment. Thus, current treatment regimens for NTM-LD are largely based on small case series, retrospective analyses, and guidelines based on expert opinions. It has been nearly 10 years since the publication of a consensus guideline for the treatment of NTM-LD. This review is a summary of the available evidence on the treatment of the major NTM-LD until more definitive studies and guidelines become available.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, University of Texas, Tyler, TX, USA

    Julie V. Philley MD

  2. Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Mary Ann DeGroote MD & Shannon Kasperbauer MD

  3. Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA

    Mary Ann DeGroote MD

  4. Department of Medicine and Academic Affairs, National Jewish Health, D509, Neustadt Building, 1400 Jackson St, Denver, CO, 80206, USA

    Jennifer R. Honda PhD, Shannon Kasperbauer MD & Edward D. Chan MD

  5. Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Jennifer R. Honda PhD, Nicholas D. Walter MD, PhD & Edward D. Chan MD

  6. University of Colorado School of Pharmacy, Aurora, CO, USA

    Michael M. Chan PharmD

  7. PharmcareUSA, Denver, CO, USA

    Michael M. Chan PharmD

  8. Department of Medicine, Denver Veterans Affairs Medical Center, Denver, CO, USA

    Nicholas D. Walter MD, PhD & Edward D. Chan MD

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  1. Julie V. Philley MD
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Correspondence to Edward D. Chan MD.

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Conflict of interest

Dr. Julie V. Philley, Dr. Jennifer R. Honda, Dr. Michael M. Chan, Dr. Shannon Kasperbauer, Dr. Nicholas D. Walter, and Dr. Edward D. Chan declare that they have no conflict of interest. Dr. Mary Ann DeGroote is a co-PI for the preclinical evaluation of new therapeutic entities for NTM therapeutics with Crestonepharma Inc. This is an SBIR phase II grant. There is no overlap with antimicrobial agents described in this review.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

The original version of this article was revised: The alignment of entries in Tables 5, 6, and 7, was incorrect. Table 5: Under the “Drug” column, it should be “± ciprofloxacin”, under “Dose and schedule” column, it should be “250-750 mg BID”, and under the “Known adverse effects” column, it should be “See moxifloxacin above” Table 6: “± Amikacin” should be moved to the right under the “Drug” column, “10-25 mg/kg IV or IM TIW for the first 2-3 months” should be moved under the “Dose and schedule” column, and “See above” should be moved under the “Known adverse effects” column. Table 7: The text for the last row is missing and is actually misplaced in the footnote: So for the last row, under the “Drug” column should be “±Trimethoprim-sulfamethoxazole”, under the “Dose and schedule” column should be “One double-strength tablet BID”, and under the “Known adverse effects” column should be “Hypersensitivity rash, myelosuppression, interstitial nephritis, increased liver function tests”

This article is part of the Topical Collection on Mycobacterial Infections

An erratum to this article is available at http://dx.doi.org/10.1007/s40506-016-0102-8.

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Philley, J.V., DeGroote, M.A., Honda, J.R. et al. Treatment of Non-Tuberculous Mycobacterial Lung Disease. Curr Treat Options Infect Dis 8, 275–296 (2016). https://doi.org/10.1007/s40506-016-0086-4

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