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Nontuberculous Myobacterial Pulmonary Disease

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5 Mycobacterium kansasii (Table 2) ➤ In patients with rifampicin-susceptible M. kansasii pulmonary disease, we suggest a regimen of rifampicin, ethambutol, and either isoniazid or macrolide (conditional recommendation, very low certainty in estimates of effect). ➤ We suggest that neither parenteral amikacin nor streptomycin be used routinely for treating patients with M. kansasii pulmonary disease (strong recommendation, very low certainty in estimates of effect). ➤ In patients with rifampicin-susceptible M. kansasii pulmonary disease, we suggest using a regimen of rifampicin, ethambutol, and either isoniazid or macrolide instead of a fluoroquinolone (conditional recommendation, very low certainty in estimates of effect). ➤ In patients with rifampicin-resistant M. kansasii or intolerance to one of the first-line antibiotics we suggest a fluoroquinolone (eg, moxifloxacin) be used as part of a second-line regimen (conditional recommendation, very low certainty in estimates of effect). ➤ In patients with noncavitary nodular/bronchiectatic M. kansasii pulmonary disease treated with a rifampicin, ethambutol, and macrolide regimen, we suggest either daily or 3 times weekly treatment (conditional recommendation, very low certainty in estimates of effect) ➤ In patients with cavitary M. kansasii pulmonary disease treated with a rifampicin, ethambutol, and macrolide-based regimen, we suggest daily treatment instead of 3 times weekly treatment (conditional recommendation, very low certainty in estimates of effect). ➤ In all patients with M. kansasii pulmonary disease treated with an isoniazid, ethambutol, and rifampicin regimen, we suggest treatment be given daily instead of 3 times weekly (conditional recommendation, very low certainty in estimates of effect). ➤ We suggest that patients with rifampin susceptible M. kansasii pulmonary disease be treated for at least 12 months (conditional recommendation, very low certainty in estimates of effect).

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