Managing pulmonary nontuberculous mycobacterial infection. time for a patient-centered approach.
The incidence of nontuberculous mycobacteria is increasing worldwide. However, the evidence base for clinical management comprises mostly expert opinion, case series, and few randomized clinical trials. Most currently recommended treatment regimens entail prolonged use of multiple antimicrobial agents associated with multiple self-limited and persistent potential adverse effects, including irreversible impairments of hearing, vision, and kidney function. Yet, little is known about how treatment impacts an individual patient's overall health status. Current treatment guidelines, although of undoubted value, are constrained by these limitations. Here we call for new studies that reassess recommendations for medical management of pulmonary nontuberculous mycobacteria infections, in particular Mycobacterium avium-intracellulare complex and Mycobacterium abscessus complex. We propose pragmatic, person-centered outcome measures that might be used in clinical assessments and new research studies, including patient-reported experience measures and patient-reported outcome measures. This will enable patients and their health-care providers to make clinical management decisions that derive from a realistic view of what they can hope to achieve from treatment.
1 Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, Royal Free Campus, London, United Kingdom.
Giovanni
G
Satta
Timothy Daniel
TD
McHugh
James
J
Mountford
Ibrahim
I
Abubakar
Marc
M
Lipman
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy*; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy; D063868:Patient Outcome Assessment; D018802:Patient-Centered Care; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000900:Anti-Bacterial Agents