Disseminated MAC — SCE Infectious Diseases MCQ

Correct answer: C — Use at least two active drugs, typically a macrolide plus ethambutol, while planning antiretroviral therapy and interaction monitoring with review

The best answer is “Use at least two active drugs, typically a macrolide plus ethambutol, while planning antiretroviral therapy and interaction monitoring with review”. Disseminated MAC requires multidrug therapy to prevent macrolide resistance and coordinated ART rather than untreated immunodeficiency. “Use isoniazid alone because all mycobacteria are tuberculosis” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use clarithromycin monotherapy despite rapid resistance” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use amphotericin B because MAC is a fungus” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Withhold ART permanently to prevent immune reconstitution” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: BHIVA opportunistic-infection guidelines: https://bhiva.org/clinical-guideline/oi-guidelines/ BTS non-tuberculous mycobacterial pulmonary-disease guideline: https://thorax.bmj.com/content/72/Suppl_2/ii1