Clinical Practice Guideline: Treatment of Nontuberculous Mycobacterial Pulmonary Disease

New guidelines for healthcare professionals caring for patients with nontuberculous mycobacteria (NTM) pulmonary disease have been compiled and an executive summary of the material was published in Clinical Infectious Diseases. The guidelines provide 31 evidence-based recommendations about treatment of NTM pulmonary disease.

NTM represent over 190 species and sub-species, some of which cause disease in humans of any age and affect both pulmonary and extrapulmonary sites. The guidelines were created by a panel of experts carefully selected by leading international respiratory medicine and infectious diseases societies and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy.

The guidelines focus on pulmonary disease in adults, without cystic fibrosis or HIV, caused by the most common NTM pathogens. Systematic reviews were conducted around 22 Population, Intervention, Comparator, Outcome (PICO) questions, and the recommendations were formulated, written, and graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

The executive summary provides a condensed version of the panel’s recommendations for the 22 PICO questions, which resulted in 31 recommendations that are organized across the following domains:  drugs to be included in the treatment regimen, frequency of administration, and duration of therapy for each NTM covered.

Species of NTM covered include Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slow-growing NTM, and Mycobacterium abscessus among the rapidly growing NTM. For detailed descriptions of the background, methods, evidence summary, and rationale supporting each recommendation, see the full text and accompanying supplementary material published online.

The panel also identified research gaps for each PICO question. According to the panel, “not surprisingly, there were many gaps and needs identified related to the treatment of NTM pulmonary disease.” The need for new drugs and treatment regimens, along with better tolerated and shorter regimens, was the focus of many of the research priorities. To evaluate new drugs and treatments, the panel stresses the need for standardized case definitions, outcome measures, and comparator regimens, as well as the ability to conduct multicenter trials.

Reference

Daley CL, Iaccarion JM, Lange C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: An official ATS/ERS/ESCMID/IDSA clinical practice guideline: Executive summary. [published online July 6, 2020]. Clin Infect Dis. doi:10.1093/cid/ciaa241