7
Table 2. Recommended Treatment Regimens for
Mycobacterium avium complex, M. kansasii,
and M. xenopi Pulmonary Disease
Organism
No. of
Drugs Preferred Drug Regimen
a
Dosing Frequency
M. aviums
Nodular-
bronchiectatic
3 Azithromycin (clarithromycin)
Rifampicin (rifabutin)
Ethambutol
3 times weekly
Cavitary ≥3 Azithromycin (clarithromycin)
Rifampicin (rifabutin)
Ethambutol
Amikacin IV (streptomycin)
b
Daily (3 times weekly
may be used with IV
aminoglycosides)
Refractory
c
≥4 Azithromycin (clarithromycin)
Rifampicin (rifabutin)
Ethambutol
Amikacin liposome inhalation
suspension
or
Amikacin IV (streptomycin)
b
Daily (3 times weekly
may be used with IV
aminoglycosides)
M. kansasii
3 Azithromycin (clarithromycin)
Rifampicin (rifabutin)
Ethambutol
Daily
3 Azithromycin (clarithromycin)
Rifampicin (rifabutin)
Ethambutol
3 times weekly
3 Isoniazid
Rifampicin (rifabutin)
Ethambutol
Daily
M. xenopi
≥3 Azithromycin (clarithromycin)
and/or moxifloxacin
Rifampicin (rifabutin)
Ethambutol
Amikacin
b
Daily (3 times weekly
may be used with IV
aminoglycosides)
a
See Table 2 for recommended dosages. Alternative drugs for patients who are intolerant of or whose
isolate is resistant to first-line drugs include clofazimine, moxifloxacin, and linezolid. Some experts
would consider bedaquiline or tedizolid.
b
Consider for cavitary, extensive nodular/bronchiectatic disease or macrolide-resistant MAC.
Amikacin or streptomycin may be given 3 times a week.
c
Refractory disease is defined as remaining sputum culture positive aer 6 months of guideline-based
therapy. Amikacin liposome inhalation suspension (ALIS) has been shown to improve culture
conversion when added to guideline-based therapy in treatment refractory patients with MAC
pulmonary disease.
