State-of-the-art treatment strategies for nontuberculous mycobacteria infections

ABSTRACT

Introduction

Non-tuberculous Mycobacteria (NTM) are a group of organisms whose importance in medicine seems to be increasing in recent times. The increasing number of patients susceptible to these diseases make it necessary to expand our knowledge of therapeutic options and to explore future possibilities for the development of a therapeutic arsenal.

Areas covered

In this review, the authors provide a brief introduction about the present importance of NTM and describe the present recommendations of the available guidelines for their treatment. They include a description of the future options for the management of these patients, especially focusing on new antibiotics. The authors also look at possibilities for future therapeutic options, such as antibiofilm strategies.

Expert opinion

No actual changes have been made to the current recommendations for the management of most NTM infections (except perhaps the availability of nebulized amikacin). However, it is also true that we have increased the number of available antibiotic treatment options with good in vitro activity against NTM. The use of these drugs in selected cases could increase the therapeutic possibilities. However, some problems are still present, such as the knowledge of the actual meaning of a NTM isolate, and will probably be a key part of future research.

KEYWORDS:

• Non-tuberculous mycobacteria
• guidelines
• treatment
• amikacin
• macrolides
• bedaquiline
• delamanid
• tigecycline
• clofazimine
• tedizolid
• omadacycline

Article highlights

• Management of Nontuberculous Mycobacterial disease is still based on previously described guidelines, with clarithromycin being the cornerstone of treatment in many of the protocols.

• New antimicrobials (Bedaquiline, delamanid, tigecycline, omadacycline, clofazimine, or tedizolid) have shown in vitro activity against some species of this group of mycobacteria, and could be potentially useful alternatives to conventional treatments in selected cases.

• Antimicrobial susceptibility testing, including molecular detection of resistance mechanisms, is of increasing usefulness in some cases where this methodology has been standardized.

• The clinical significance of a NTM isolate in some (mainly respiratory) samples is still difficult to determine.

• Furthermore, detection of repeated isolates of the same species remains the method for determining the clinical significance of NTM in patients with compatible symptoms. Removal of biomaterials is an essential part of the treatment of infections where these devices are present, in order to obtain full patient recovery.

This box summarizes key points contained in the article.

Acknowledgments

We want to acknowledge Dr. Bernadette G. Pfang for her review of the English language of the manuscript.

Declaration of Interest

J Esteban has received travelling fees from Pfizer Inc, Biomérieux and Angelini. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.