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Non-progressive MAC isolation — SCE Respiratory MCQ

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HardTuberculosis and NTMNon-progressive MAC isolationSCE Respiratory

A 68-year-old woman with nodular bronchiectasis has two sputum cultures positive for Mycobacterium avium complex but feels well. She has minimal cough, stable weight and CT changes are unchanged over 18 months. Smear is negative, FEV1 is 82% predicted and she prefers to avoid adverse effects. The MDT confirms she does not currently meet treatment threshold. What is the most appropriate management?

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Correct answer: D — Structured observation with repeat sputum and imaging review

The best answer is “Structured observation with repeat sputum and imaging review”. Structured observation with repeat sputum and imaging review is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Macrolide monotherapy to suppress cultures, after safety review”, “Immediate intravenous amikacin for twelve weeks, after specialist assessment”, “Empirical antituberculous therapy, within a respiratory pathway”, “Discharge in the absence of further microbiology, within a respiratory pathway”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for bronchiectasis in adults: https://thorax.bmj.com/content/74/Suppl_1/1