NTM Species | ATS/IDSA Guidelines a | BTS Guidelines b |
---|---|---|
M. abscessus | Minimal surgical resurrection Macrolide (Clarithromycin 500–1,000 mg/day); Intravenous amikacin; streptomycin or cefotaxime | Clarithromycin-sensitive or inducible macrolide-resistant isolates Initial phase: ≥1 month intravenous Amikacin 15 mg/kg daily or 3×per week; intravenous Tigecycline 50 mg twice daily; where tolerated intravenous Imipenem 1 g twice daily; where tolerated oral Clarithromycin 500 mg twice daily or oral Azithromycin 250–500 mg daily. Continuation phase: nebulized Amikacin and oral Clarithromycin 500 mg twice daily or azithromycin 250–500 mg daily plus oral clofazimine 50–100 mg daily; oral linezolid 600 mg daily or twice daily; oral minocycline 100 mg twice daily; oral moxifloxacin 400 mg daily; oral cotrimoxazole 960 mg twice daily based on the guidance of DST and patient tolerance. Constitutive macrolide-resistant isolates Same as above, except Clarithromycin is omitted in both phases. |
MAC (M. avium complex) | Non-severe MAC-PD Clarithromycin 1,000 mg or Azithromycin 500 mg, Ethambutol 25 mg/kg, and Rifampin 600 mg administered three times per week Severe MAC-PD Clarithromycin 500–1,000 mg/day; Azithromycin 250 mg/ day; Ethambutol 15 mg/kg/day; Rifampin 10 mg/kg/day all daily; Intravenous drugs like amikacin or streptomycin | Non-severe MAC-PD Rifampicin 600 mg 3 x per week; Ethambutol 25 mg/kg 3×per week; Azithromycin 500 mg 3×per week or Clarithromycin 1 g in two divided doses 3 x per week. Severe MAC-PD Rifampicin 600 mg daily; Ethambutol 15 mg/kg daily; Azithromycin 250 mg daily or Clarithromycin 500 mg twice daily; Intravenous amikacin for up to 3 months or nebulized amikacin Clarithromycin-resistant MAC PD Rifampicin 600 mg daily; Ethambutol 15 mg/kg daily; Isoniazid 300 mg (+pyridoxine 10 mg) daily or moxifloxacin 400 mg daily Intravenous amikacin for up to 3 months or nebulized amikacin |
M. kansasii | Rifampicin-sensitiveM. kansasii-PD Rifampin 10 mg/kg/day; Ethambutol 15 g/kg/day; Isoniazid 5 mg/kg/day; Pyridoxine (50 mg/day) - Daily Rifampicin-resistantM. kansasii-PD Three drug regimen – with guidance from DST | Rifampicin-sensitiveM. kansasii-PD Rifampicin 600 mg daily; Ethambutol 15 mg/kg daily; Isoniazid 300 mg (with pyridoxine 10 mg) daily or azithromycin 250 mg daily or clarithromycin 500 mg twice daily. Rifampicin-resistantM. kansasii-PD Three drug regimen – with guidance from DST |
M. malmoense | Isoniazid; Rifampicin; Ethambutol; With or without Quinolones and Macrolides with guidance from DST (dose not specified) | Non-severeM. malmoense-PD Rifampicin 600 mg daily; Ethambutol 15 mg/kg daily; Azithromycin 250 mg daily or Clarithromycin 500 mg twice daily. SevereM. malmoense-PD Same as above plus intravenous amikacin for up to 3 months or nebulized amikacin. |
M. xenopi | Isoniazid; Rifabutin or Rifampin; Ethambutol, and Clarithromycin, with or without an initial course of Streptomycin plus inclusion of a Quinolone, preferably moxifloxacin to be substituted for one of the anti-tuberculous drugs | Non-severeM. xenopi-PD Rifampicin 600 mg daily; Ethambutol 15 mg/kg daily; Azithromycin 250 mg daily or Clarithromycin 500 mg twice daily; Moxifloxacin 400 mg daily or Isoniazid 300 mg (+pyridoxine 10 mg) daily SevereM. xenopi-PD Same as above plus intravenous amikacin for up to 3 months or nebulized amikacin. |