Treatment strategies for Mycobacterium avium pulmonary disease

Macrolides are known to play a key role in the treatment of nontuberculous mycobacteria. However, the optimal combination and number of drugs remains uncertain. Nagawawa et al. and Zweijpfenning et al. investigated these questions in two randomised controlled trials exploring treatment regimens for Mycobacterium avium complex (MAC) infections, while Nguyen et al. summarised some of these questions in a meta-analysis. Nagawawa et al. compared an intermittent three-drug regimen to daily therapy, while Zweijpfenning et al. compared rifampicin or clofazimine as adjuncts to ethambutol and a macrolide. Tolerance levels for intermittent therapy were not significantly superior to those of daily therapy, while a clofazimine-ethambutol-macrolide regimen was non-inferior to one including rifampicin. Finally, Nguyen et al. conclude that a two-drug regimen may be a viable option for treating MAC infections.