When mycobacterium identified, treatment geared towards MTB for therapeutic and public health reasons, especially for children with lung disease.
NTM grow slowly, thus treatment directed at MTB rather than NTM won't have a negative outcome on the NTM infection.
Guidelines for mgmt of NTM based on retrospective adult data.
Therapeutic results for MAI pulmonary disease are poor, based on failure rates of 25-65%. Combination therapy included 4-6 drugs before clarithromycin.
Relapse in as many as 25% of those who initially cleared the organism (Krause et al, Peds Infect. J, 1996)
Four drug regimen (isoniazid, rifampin, ethambutol, Clarithromycin) initially to cover both MTB and NTM
Once NTM identified, multiple drug therapy for 6-12 months
No role for single agent therapy because of increased risk of resistance
Multiple drug therapy for > 12 months: Rifabutin, clarithromycin, ethambutol, amikacin.
No guidelines regarding need for surgery. Role for surgery in localized disease or endobronchial compression.
One reported case of medical therapy and laser bronchoscopy without surgery with good outcome.
investigations and therapy
Full immunological workup including HIV required in those with atypical mycobacterium
? Genetic defect in TNFa, and IL12 implicated
? Role for gamma INF in children (used successfully in adults with HIV)
? Use of GM-CSF, G-CSF in disseminated disease, not known in children
in insolated pulmonary disease, reported mortality is 20% however the immune status is not known (Alan et al Pediatr infect Dis J 1992).
Generally good without underlying immunodeficiency
Variable follow-up and treatment from case reports
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