title: Nontuberculous Mycobacteria in Cystic Fibrosis.
abstract: Nontuberculous mycobacteria (NTM) are found in approximately 10 % of cystic fibrosis (CF) patients, but only a portion will develop NTM disease. The management of CF lung disease should be optimized, including antibiotic therapy targeted to the individual's usual airway bacteria, prior to considering treatment for NTM lung disease. Those who meet criteria for NTM lung disease may not necessarily require treatment and could be monitored expectantly if symptoms and radiographic findings are minimal. However, the presence ofMycobacterium abscessuscomplex (MABSC), severe lung disease, and/or anticipated lung transplant should prompt NTM therapy initiation. For CF patients withMycobacterium aviumcomplex (MAC), recommended treatment includes triple antibiotic therapy with a macrolide, rifampin, and ethambutol. Azithromycin is generally our preferred macrolide in CF as it is better tolerated and has fewer drug-drug interactions. MABSC treatment is more complex and requires an induction phase (oral macrolide and two IV agents including amikacin) as well as a maintenance phase (nebulized amikacin and two to three oral antibiotics including a macrolide). The induction phase may range from one to three months (depending on infection severity, treatment response, and medication tolerability). For both MAC and MABSC, treatment duration is extended 1-year post-culture conversion. However, in patients who do not achieve culture negative status but tolerate therapy, we consider ongoing treatment for mycobacterial suppression and prevention of disease progression.
authors.affiliation: Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta Canada ; Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada ; Rockyview General Hospital Respirology Offices, 7007 14th Street SW, Calgary, AB T2V 1P9 Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Skolnik
authors.affiliation: Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Kirkpatrick
authors.affiliation: Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada ; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC Canada ; St. Paul's Hospital, 8B Providence Wing, 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Quon
keywords: Cystic fibrosis; Mycobacterium abscessus; Mycobacterium avium complex; Nontuberculous mycobacteria