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)
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