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Table 3 Description of drugs used in the treatment of adults with NTM diseases based on the ATS/IDSA/BTS Guidelines

From: Of tuberculosis and non-tuberculous mycobacterial infections – a comparative analysis of epidemiology, diagnosis and treatment

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.
  1. Ref ([93]a[87]b). PD Pulmonary disease; DST Drug sensitivity testing, ATS American Thoracic Society; IDSA Infectious Disease Society of America; BTS British Thoracic Society.