Treatment of Nontuberculous Mycobacterial Pulmonary Disease: an Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline

Overview

Journal Eur Respir J

Specialty Pulmonary Medicine

Date 2020 Jul 9

PMID 32636299

Citations 281

Authors

Charles L Daley

Jonathan M Iaccarino

Christoph Lange

Emmanuelle Cambau

Richard J Wallace Jr

Claire Andrejak

Erik C Bottger

Jan Brozek

David E Griffith

Lorenzo Guglielmetti

Gwen A Huitt

Shandra L Knight

Philip Leitman

Theodore K Marras

Kenneth N Olivier

Miguel Santin

Jason E Stout

Enrico Tortoli

Jakko van Ingen

Dirk Wagner

Kevin L Winthrop

Affiliations

Soon will be listed here.

Abstract

Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as complex, , and among the slowly growing NTM and among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.

Citing Articles

A Rare Pathogenic Masquerader of Pulmonary Disease: A Case Report.

Karimi R, Adlakha A Cureus. 2025; 17(2):e78822.

PMID: 40078246 PMC: 11902884. DOI: 10.7759/cureus.78822.

Pulmonary nontuberculous mycobacterial infections among women with cystic fibrosis and non-cystic fibrosis bronchiectasis.

Gross J, Jones M, Buige A, Prevots D, Kasperbauer S Ther Adv Respir Dis. 2025; 19:17534666251323181.

PMID: 40071337 PMC: 11898043. DOI: 10.1177/17534666251323181.

A Year in Review on Tuberculosis and Non-tuberculous Mycobacteria Disease: A 2025 Update for Clinicians and Scientists.

Lange C, Bothamley G, Gunther G, Guglielmetti L, Kontsevaya I, Kuksa L Pathog Immun. 2025; 10(2):1-45.

PMID: 40062355 PMC: 11888605. DOI: 10.20411/pai.v10i2.791.

Challenges in achieving the guideline-recommended amikacin level for complex pulmonary disease.

Akutsu T, Tone K, Hasegawa A, Kitayama T, Inaki S, Gochi M J Clin Tuberc Other Mycobact Dis. 2025; 39:100514.

PMID: 40035075 PMC: 11874810. DOI: 10.1016/j.jctube.2025.100514.

Utility of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) Imaging for Evaluating Treatment Efficacy in Mycobacterium avium Complex Pulmonary Disease.

Takazono T, Hosogaya N, Ideguchi R, Yoshida M, Takeda K, Ide S Cureus. 2025; 17(3):e79891.

PMID: 40034415 PMC: 11872242. DOI: 10.7759/cureus.79891.

References

. Mycobacterium kansasii pulmonary infection: a prospective study of the results of nine months of treatment with rifampicin and ethambutol. Research Committee, British Thoracic Society. Thorax. 1994; 49(5):442-5. PMC: 474863. DOI: 10.1136/thx.49.5.442. View

Shitrit D, Baum G, Priess R, Lavy A, Bar-Gil Shitrit A, Raz M . Pulmonary Mycobacterium kansasii infection in Israel, 1999-2004: clinical features, drug susceptibility, and outcome. Chest. 2006; 129(3):771-6. DOI: 10.1378/chest.129.3.771. View

Johnston I . Mycobacterium xenopi infection and aspergilloma. Tubercle. 1988; 69(2):139-43. DOI: 10.1016/0041-3879(88)90077-3. View

Alcaide F, Benitez M, Escriba J, Martin R . Evaluation of the BACTEC MGIT 960 and the MB/BacT systems for recovery of mycobacteria from clinical specimens and for species identification by DNA AccuProbe. J Clin Microbiol. 2000; 38(1):398-401. PMC: 88732. DOI: 10.1128/JCM.38.1.398-401.2000. View

. First randomised trial of treatments for pulmonary disease caused by M avium intracellulare, M malmoense, and M xenopi in HIV negative patients: rifampicin, ethambutol and isoniazid versus rifampicin and ethambutol. Thorax. 2001; 56(3):167-72. PMC: 1758783. DOI: 10.1136/thorax.56.3.167. View

Jeong B, Jeon K, Park H, Moon S, Kim S, Lee S . Peak Plasma Concentration of Azithromycin and Treatment Responses in Mycobacterium avium Complex Lung Disease. Antimicrob Agents Chemother. 2016; 60(10):6076-83. PMC: 5038230. DOI: 10.1128/AAC.00770-16. View

Koh W, Kim Y, Kwon O, Choi Y, Kim K, Shim Y . Surgical treatment of pulmonary diseases due to nontuberculous mycobacteria. J Korean Med Sci. 2008; 23(3):397-401. PMC: 2526522. DOI: 10.3346/jkms.2008.23.3.397. View

van Ingen J, Bendien S, de Lange W, Hoefsloot W, Dekhuijzen P, Boeree M . Clinical relevance of non-tuberculous mycobacteria isolated in the Nijmegen-Arnhem region, The Netherlands. Thorax. 2009; 64(6):502-6. DOI: 10.1136/thx.2008.110957. View

Novosad S, Beekmann S, Polgreen P, Mackey K, Winthrop K . Treatment of Mycobacterium abscessus Infection. Emerg Infect Dis. 2016; 22(3):511-4. PMC: 4766900. DOI: 10.3201/eid2203.150828. View

10.

Bakula Z, Modrzejewska M, Pennings L, Proboszcz M, Safianowska A, Bielecki J . Drug Susceptibility Profiling and Genetic Determinants of Drug Resistance in Mycobacterium kansasii. Antimicrob Agents Chemother. 2018; 62(4). PMC: 5913922. DOI: 10.1128/AAC.01788-17. View

11.

Srivastava S, Pasipanodya J, Sherman C, Meek C, Leff R, Gumbo T . Rapid drug tolerance and dramatic sterilizing effect of moxifloxacin monotherapy in a novel hollow-fiber model of intracellular Mycobacterium kansasii disease. Antimicrob Agents Chemother. 2015; 59(4):2273-9. PMC: 4356829. DOI: 10.1128/AAC.04441-14. View

12.

Gluud C, Als-Nielsen B, Damgaard M, Hansen J, Hansen S, Helo O . Clarithromycin for 2 weeks for stable coronary heart disease: 6-year follow-up of the CLARICOR randomized trial and updated meta-analysis of antibiotics for coronary heart disease. Cardiology. 2008; 111(4):280-7. PMC: 2820332. DOI: 10.1159/000128994. View

13.

Griffith D, Brown B, Cegielski P, Murphy D, Wallace Jr R . Early results (at 6 months) with intermittent clarithromycin-including regimens for lung disease due to Mycobacterium avium complex. Clin Infect Dis. 2000; 30(2):288-92. DOI: 10.1086/313644. View

14.

Jankovic M, Sabol I, Zmak L, Jankovic V, Jakopovic M, Obrovac M . Microbiological criteria in non-tuberculous mycobacteria pulmonary disease: a tool for diagnosis and epidemiology. Int J Tuberc Lung Dis. 2016; 20(7):934-40. DOI: 10.5588/ijtld.15.0633. View

15.

Peres R, Maciel E, Morais C, Ribeiro F, Vinhas S, Pinheiro C . Comparison of two concentrations of NALC-NaOH for decontamination of sputum for mycobacterial culture. Int J Tuberc Lung Dis. 2009; 13(12):1572-5. View

16.

Guyatt G, Oxman A, Kunz R, Atkins D, Brozek J, Vist G . GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol. 2011; 64(4):395-400. DOI: 10.1016/j.jclinepi.2010.09.012. View

17.

Roth A, Fischer M, Hamid M, Michalke S, Ludwig W, Mauch H . Differentiation of phylogenetically related slowly growing mycobacteria based on 16S-23S rRNA gene internal transcribed spacer sequences. J Clin Microbiol. 1998; 36(1):139-47. PMC: 124824. DOI: 10.1128/JCM.36.1.139-147.1998. View

18.

Ikedo Y . The significance of bronchoscopy for the diagnosis of Mycobacterium avium complex (MAC) pulmonary disease. Kurume Med J. 2001; 48(1):15-9. DOI: 10.2739/kurumemedj.48.15. View

19.

Harada T, Akiyama Y, Kurashima A, Nagai H, Tsuyuguchi K, Fujii T . Clinical and microbiological differences between Mycobacterium abscessus and Mycobacterium massiliense lung diseases. J Clin Microbiol. 2012; 50(11):3556-61. PMC: 3486228. DOI: 10.1128/JCM.01175-12. View

20.

van Ingen J, de Zwaan R, Dekhuijzen R, Boeree M, van Soolingen D . Clinical relevance of Mycobacterium chelonae-abscessus group isolation in 95 patients. J Infect. 2009; 59(5):324-31. DOI: 10.1016/j.jinf.2009.08.016. View