Daily treatment
Clarithromycin 500-1000 or azithro 250/day
Rifampin 600 mg,or rifabutin 150-300 mg
Ethambutol 15 mg/Kg,
+/- 3 times weekly amikacin or streptomycin for 3
months.
Treatment continued until culture negative for 1
year.
Treatment of Macrolide-resistant MAC Lung
Disease
Analogous to treatment for drug resistant TB
Risk factor for resis: macrolide monotheray,
inadequate companion drug use.
Parenteral aminoglycoside: parenteral
streptomycin or amikacin
Surgical resection (debulking)
4 drug regimen: INH, Rifampin, ethambutol,
streptomycin for 3-6 mo moxifloxacin?
INF gamma?
MAC disseminated
Mycobacteria phagocytosed by
macrophages, which produce IL-12, which
up-regulates IFN-gamma. INF-gamma
activates neutrophils and macrophages to
kills intracellular pathogens.
Positive feed back loop between INF-
gamma and IL-12. Disseminated NTM is
manifestation of immunologic defect.
Pulmonary Disease with NTM