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.

Nontuberculous%20mycobacterial%20disease Management

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!
Sign In To Download
Editor's Recommendations
Most Read Articles
20 Jun 2020
The Lundbeck Neuroscience Symposium was held at Sofitel KL Damansara over 2 days, with extensivediscussions on the management of various mental illnesses. The second day of the symposiumaddressed the topic of schizophrenia management, focusing on treatment goals, the rationale forpartial dopamine D(2) receptor agonism and the use of long-acting injectable (LAI) antipsychotics topromote adherence.
Pearl Toh, 5 days ago
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
4 days ago
Patients with psoriatic arthritis (PsA) often suffer from liver abnormalities, which are associated with higher body mass index (BMI), daily consumption of alcohol, more severe disease, and some therapies, according to a recent study.
Christina Lau, 3 days ago

Pembrolizumab in combination with chemotherapy significantly improves progression-free survival (PFS) vs chemotherapy alone in patients with previously untreated, locally recurrent inoperable or metastatic triple-negative breast cancer (TNBC), results of the KEYNOTE-355 study have shown.