3
Treatment
Systematic reviews were conducted around each of 22 PICO (Population,
Intervention, Comparator, Outcome) questions and the guidelines provide evidence-
based recommendations that have been developed using GR ADE (Grading of
Recommendations, Assessment, Development, and Evaluation) methodolog y. GR ADE
involves structured literature review, systematic reviews and meta-analyses of combined
data, and expert discussion to assess the certainty in the evidence and determine the
strength of each recommendation. (See Table 7)
Treatment of NTM Pulmonary Disease (Table 3)
➤ In patients who meet the diagnostic criteria for NTM pulmonary
disease (Table 1), we suggest initiation of treatment rather than
watchful waiting, especially in the context of positive acid-fast
bacilli sputum smears and/or cavitary lung disease (conditional
recommendation, very low certainty in estimates of effect).
➤ In patients with MAC pulmonary disease, we suggest susceptibility-
based treatment for macrolides and amikacin over empiric therapy
(conditional recommendation, very low certainty in estimates of effect).
➤ In patients with M. kansasii pulmonary disease, we suggest
susceptibility-based treatment for rifampicin over empiric therapy
(conditional recommendation, very low certainty in estimates of effect).
➤ In patients with M. xenopi pulmonary disease, the panel members
felt there is insufficient evidence to make a recommendation for or
against susceptibility-based treatment.
➤ In patients with M. abscessus pulmonary disease we suggest
susceptibility-based treatment for macrolides and amikacin over
empiric therapy (conditional recommendation, very low certainty in
estimates of effect).
For macrolides, a 14-day incubation and/or sequencing of the erm(41) gene is required
in order to evaluate for potential inducible macrolide resistance.
