What are the British Thoracic Society Guidelines on the treatment of mycobacterium chelonae infection?

Updated: Dec 20, 2018
  • Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Clarithromycin-sensitive MAC pulmonary disease should be treated with rifampicin, ethambutol, and clarithromycin or azithromycin using an intermittent (3 times per week) or daily oral regimen. The choice of regimen should be based on the severity of disease and treatment tolerance.

An intermittent (3 times per week) oral antibiotic regimen should not be used in individuals with severe MAC pulmonary disease or in individuals with a history of treatment failure.

An injectable aminoglycoside (amikacin or streptomycin) should be considered in individuals with severe MAC pulmonary disease.

Clarithromycin-resistant MAC pulmonary disease should be treated with rifampicin, ethambutol, and isoniazid or a quinolone, and consider an injectable aminoglycoside (amikacin or streptomycin).

Nebulized amikacin may be considered in place of an injectable aminoglycoside when intravenous/intramuscular administration is impractical or contraindicated or when longer-term treatment with an aminoglycoside is required for the treatment of MAC pulmonary disease.

Macrolide monotherapy or macrolide/quinolone dual therapy regimens should not be used for the treatment of MAC pulmonary disease.

Antibiotic treatment for MAC pulmonary disease should continue for a minimum of 12 months after culture conversion. [39]


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