nontuberculous%20mycobacterial%20disease
NONTUBERCULOUS MYCOBACTERIAL DISEASE
Nontuberculous mycobacteria are ubiquitous and are usually found in soil, natural and treated water sources. They are relatively uncommon cause of pulmonary disease and likely to cause disseminated disease.
May cause both asymptomatic infection and symptomatic disease in humans.
There is no evidence of animal-to-human or human-to-human transmission in immunocompetent hosts.
Nontuberculous mycobacterial pulmonary disease is a generally slowly progressive infection.
Signs and symptoms are generally nonspecific.

Monitoring

Continual Monitoring

  • Patients should have frequent sputum mycobacterial culture throughout the therapy
  • The risk of adverse reactions &/or toxicities is relatively high in multidrug therapy

When monitoring for improvement, take into account the following factors:

  • Symptomatic improvement after 6 months of appropriate therapy
  • Radiographic regression of pulmonary findings after 6 months of appropriate therapy
  • Conversion of sputum smear &/or culture to negative after 12 months of appropriate therapy

Evaluate Patients for Adverse Drug Reactions

GI Disturbances

  • Associated w/ Clarithromycin, Azithromycin
    • Dose & serum level related
  • May also be seen w/ Rifabutin, Rifampicin
  • Include metallic taste, vomiting, nausea, diarrhea

Rash

  • Hypersensitivity reactions are seen w/ Rifampicin, Rifabutin

Arthralgia

  • Commonly seen w/ Rifabutin

Ocular Toxicity

  • Seen w/ Ethambutol, Rifabutin

Vestibular or Auditory Toxicity

  • Seen w/ Azithromycin, Streptomycin, Amikacin

Monitor Laboratory Measurements as Necessary

  • Monitor hematologic parameters, especially white blood cells in patients taking Rifabutin
  • Monitor visual acuity (for Ethambutol, Rifabutin), red-green discrimination (for Ethambutol)
  • Monitor LFT in patients taking the following drugs: Clarithromycin, Azithromycin, Rifabutin, Rifampicin, Isoniazid, Ethionamide
  • Monitor renal function (for Rifabutin)
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Audrey Abella, 16 Feb 2017
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) during acute respiratory infection episodes may increase the risk of acute myocardial infarction (MI), a recent study from Taiwan shows.
Pearl Toh, 01 Mar 2016
Asthma development in young children may be associated with paracetamol exposure during maternal pregnancy or infancy, a new study on the MoBa* cohort showed.
Stephen Padilla, 04 Dec 2017
About one in five (~20 percent) of lower respiratory tract illnesses (LRTIs) involve respiratory viruses irrespective of the presence of asthma exacerbation, according to a Korea study presented at the 22nd Congress of the Asian Pacific Society of Respirology (APSR) held in Sydney, Australia.
Pearl Toh, 06 Jan 2017
The experimental Ebola virus vaccine rVSV-ZEBOV shows 100 percent efficacy in protecting against the disease, assessed from day 10 onwards, according to final data from the Ebola ça Suffit!* (which translates to “Ebola that’s enough!”) trial in Guinea and Sierra Leone.