Nontuberculous Mycobacteria: Diagnosis and Therapy

Patients with bronchiectasis are at high risk for nontuberculous mycobacteria (NTM) disease and suspicion should be high in the setting of worsening respiratory symptoms and disease progression on imaging. Meeting the case definition for NTM disease does not equal a decision to treat; risk and benefits of therapy should be discussed with patients. When treatment is initiated, a multidrug regimen should be used and selected based on susceptibility testing from a reliable laboratory. Monotherapy or macrolide-fluoroquinolone dual therapy should never be used. After discontinuation of therapy, ongoing mycobacterial sputum culture surveillance is needed, as infection relapse is common.