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Non-tuberculous Mycobacteria — SCE Infectious Diseases MCQ

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HardTuberculosisNon-tuberculous MycobacteriaSCE Infectious Diseases

A 62-year-old man with bronchiectasis has Mycobacterium avium complex (MAC) isolated from three separate sputum samples. CT chest shows nodular bronchiectatic changes in the right middle lobe and lingula. He has no systemic symptoms. What is the most appropriate treatment?

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Correct answer: C — Rifampicin, Ethambutol, and Clarithromycin three times per week

For nodular/bronchiectatic MAC pulmonary disease without cavitation, BTS guidelines recommend an intermittent (three times per week) regimen of Rifampicin, Ethambutol, and a macrolide (Clarithromycin or Azithromycin). Treatment should continue until 12 months of negative sputum cultures. Macrolide monotherapy risks resistance emergence. For cavitary MAC disease, daily dosing is recommended instead. Isoniazid has no activity against MAC.

Reference: BTS 2017 – Guidelines for the management of non-tuberculous mycobacterial pulmonary disease