There are different goals of therapy. Of course, the most important goal is cure.
Depending on the species, that may be possible. Cure is defined by a microbiologic outcome. If sputum cultures become negative and remain negative after treatment that is a microbiologic cure. We also follow clinical symptoms and anticipate that treatment results in resolution of fevers, night sweats, cough, etc. finally, we follow imaging (CT scans of the chest) while on treatment. We monitor for improvement in nodularity, closure of cavities and decrease in inflammation.
Most of the nontuberculous mycobacteria are naturally resistant to common antibiotics. The treatment regimens recommended vary greatly depending on the species. Some of medications used to treat NTM happen to treat tuberculosis (TB) as well. To overcome drug resistance, people with NTM may need to take several different antibiotics at the same time. Typically, the regimen includes three antibiotics. Because these medications may have side effects, close monitoring is important. Furthermore, treatment may be necessary for as long as two years. The goal of treatment is to achieve “negative” sputum cultures and maintain that for 12 months before stopping. Sometimes treatment is ongoing, depending on the severity of the disease.
The most common organisms involved in human infection are M. avium complex, M. kansasii and M. abscessus. M. kansasii is easier to treat and often can be killed with only three anti-TB medications. On the other hand, organisms such as M. avium complex, M. chelonae and M. abscessus are among the most stubborn germs. They are more difficult to treat. Three to five medications may be needed. Depending on how localized the disease is, surgery also may be helpful.