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Treatment of nontuberculous mycobacterial infections of the lung in HIV-negative patients

David E Griffith, MD
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Allyson Bloom, MD


Treatment of nontuberculous mycobacterial (NTM) infection of the lung, as in other body sites, is dependent upon the species of the infecting organism. The three most common pulmonary syndromes due to NTM are caused by Mycobacterium avium complex (MAC), Mycobacterium kansasii, and Mycobacterium abscessus [1,2].

In the past, NTM were commonly believed to be laboratory contaminants or to colonize airways without causing disease. However, it has become evident that prolonged (more than two weeks) airway colonization with no histopathologic host response is uncommon in symptomatic patients who are undergoing diagnostic evaluation [2-4]. On the other hand, low numbers of organisms that are recovered from single specimens may not be the major cause of the patient's symptoms and may clear without antimicrobial drugs. Furthermore, disease may range in severity from subclinical or low-grade infection to extensive destruction of the lungs. Patients who are immunocompromised by virtue of AIDS, hemolymphatic malignancies, or immunosuppressive drugs have a much greater tendency to develop disseminated disease than immunologically intact individuals [5-7].

More effective drugs are needed for the treatment of NTM, and it is hoped that better agents will emerge given the recent interest in developing more effective antituberculosis drugs, which has been stimulated by the need for improved therapy of drug-resistant tuberculosis.

The treatment of NTM pulmonary infection will be reviewed here. The diagnosis, clinical manifestations, and microbiology of NTM infection, infection due to rapidly growing mycobacterium, and infection with Mycobacterium marinum and Mycobacterium ulcerans are discussed separately. (See "Diagnosis of nontuberculous mycobacterial infections of the lungs in HIV-negative patients" and "Overview of nontuberculous mycobacterial infections in HIV-negative patients" and "Microbiology of nontuberculous mycobacteria" and "Rapidly growing mycobacterial infections in HIV-negative patients".)


Treatment of presumed NTM infection is indicated in patients with the following findings (table 1) [2]:


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Literature review current through: Sep 2016. | This topic last updated: Aug 21, 2014.
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