Nontuberculous Mycobacteria: Update on Diagnosis and Treatment
"Treatment is also difficult and often controversial, requiring prolonged, poorly tolerated courses of therapy that are unlikely to produce eradication."
EDITOR'S NOTE: The video below presents the conventional medical treatment for NTM disease. Although the standard treatment does not offer a certain cure for some antibiotic resistant strains, such as M. abscessus, medical centers and specialists continue to prescribe the long-term, multi-antibiotic regimen which includes medications with serious side effects.
Mycobacterium abscessus - source: Johns Hopkins Guides
"Considered among the most pathogenic and chemotherapy-resistant of rapid-growing mycobacterium."
"Treatment duration: 6 months for extrapulmonary, at least 12 months for pulmonary."
"Often not considered a medically curable condition, but rather that antibiotics contain the infection from spreading."
"Surgery, if feasible, is only known predictably curative strategy."
Johns Hopkins Guide - Mycobacterium abscessus
Identification of antimicrobial activity among FDA-approved drugs for combating Mycobacterium abscessus and Mycobacterium chelonae
EDITOR'S NOTE: The fact that our co-editor was able to utilize a regimen beyond antibiotics that helped him recover from M. abscessus should be of interest to researchers.
The Talking Mycobacterium abscessus Blues
"Progress has been painfully and frustratingly slow with M. abscessus disease, and the goal that this disease can be viewed as predictably curable is not in sight."
Mycobacterium avium-complex (MAC, MAI, non-HIV) - Source: Johns Hopkins Guides
"Monitoring for drug toxicity is essential given the long duration of therapy and typical older age of affected individuals: rifampin (hepatitis), rifabutin (uveitis especially when used with macrolide, hepatitis, polyarthralgias), ethambutol (retrobulbar neuritis manifest by decreased visual acuity or red-green color discrimination), amikacin (ototoxicity, nephrotoxicity), clarithromycin (GI upset), azithromycin (reversible hearing loss, GI upset)."
Johns Hopkins Guide - Mycobacterium avium-complex
Source: The American Society for Microbiology, Antimicrobial Agents and Chemotherapy
"... treatment failure with antibiotics alone is common in the clinical setting of M. abscessus pulmonary infection. Determination of the efficacies of new antibiotics should include an assessment of their activities against the smooth and rough M. abscessus morphotypes in biofilms and macrophages."
"All three antibiotics had only a bacteriostatic effect against M. abscessus within macrophages, which may also account for the refractoriness of invasive pulmonary infection to antibiotic therapy."
Nontuberculosis (Environmental) Mycobacterial Disease
"The treatment of environmental mycobacterial infections is almost always more complicated than the treatment of tuberculosis. The drugs, frequency of administration, and duration of therapy will vary depending on the species of NTM causing the disease, site of infection, and extent of disease."
"A cure is seldom achieved in patients with pulmonary M. abscessus infection."
EDITOR'S NOTE: The cost of treatment is massively disproportionate to patient outcomes for many forms of nontuberculosis mycobacteria disease. In a 2007 manuscript about NTM disease, a group of top specialists stated that the recommended treatment is "based not on empirically derived data, but rather on expert opinion." If this is true, what is the science behind the opinion?
An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases (2007)
"Large gaps still exist in our knowledge. Limitations in systematic data have made it necessary for many of the recommendations in this document to be based on expert opinion rather than on empirically derived data."
"Treatment of M. abscessus pulmonary disease. There are no drug regimens of proven or predictable efficacy for treatment of M. abscessus lung disease. Multidrug regimens that include clarithromycin 1,000 mg/day may cause symptomatic improvement and disease regression. Surgical resection of localized disease combined with multidrug clarithromycin-based therapy offers the best chance for cure of this disease."