Treatment

Aim
Prevent morbidity and death while
preventing drug resistance
Interrupt transmission by rendering
patients non-infectious

Requires constant administrax of at

least 2 agents to which the organism
is susceptible

 First-line drugs
isoniazid, rifampim, pyrazinamide,
ethambutol
Rifapentine, rifabutin

Second-line drugs
Fluoroquinolines, aminoglycosides,
capreomycin, ethionamide and
prothionamide, cycloserine and terizidone
and PAS

Severe cases
Diarylquinoline bedaquiline
Nitroimidazole delamanid

MAC
Ubiquitous in soil and water
hot tub lung
Rarely cause disease unless
immunocompromised
3-15% - bronchiectasis
Pathophysiology is assumed to be similar
to MTB

 Portal of entry: bowel

bone marrow bloodstream
Fever, malaise, wt loss
c organomegaly, lympadenopathy, anemia

Pulmonary disease
Months or years of throat clearing, nagging
cough and slowly progressive fatigue
Most commonly in women in 6th-7th decade
with chest wall AbN
Bronchiectasis, pneumoconiosis, COPD,
primary ciliary dyskinesia, a1 antitrypsin
def, cystic fibrosis

tx
Multidrug tx

Macrolide (clarithromycin/azithromycin)
Ethambutol
Rifamycin
Prolonged duration: >12 mos (18mos)

Prognosis
Dependent on underlying condition
Range: recovery to death