NTM Treatment: Taking the “Big 3”

Posted on February 06, 2023   |   
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This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Treatment for NTM lung disease can be overwhelming for patients, their families, and caregivers. Good communication across the health care team is important for those needing NTM treatment.

Management and treatment of NTM lung infections usually include multiple specialists to help deliver the best quality of care. The health care teams for those who have NTM lung disease may include pulmonologists (lung doctors), infectious disease specialists (someone who specializes in the treatment of infections), primary care physicians, nurses, respiratory therapists, pharmacists, surgeons, dietitians/nutritionists, and mental health care providers.

Before someone with NTM lung disease starts a treatment plan involving medication, they should talk to their health care teams about the following topics.

  • How long they will be taking the medicines
  • How will they know if the medicines are working
  • Follow-up appointments
  • Any possible side effects
  • How will questions and side effects be handled if they arise

Talking about what to expect in the months ahead may help people taking medicines for NTM lung disease stay on their treatment plan. Worry and anxiety often related to taking medicines for a long period may decrease once a person understands the treatment plan ahead.

The goals of the treatment of NTM lung disease vary between patients but may include improvement in symptoms, stabilization of abnormal CT scan or chest x-ray results, and/or improvement in sputum culture results. In 2020, experts in the field of NTM lung disease developed guidelines for treating the most common NTM infections, including Mycobacterium Avium Complex (also known as MAC) and Mycobacterium abscessus. Instead of treating the NTM with one medicine, experts recommend taking 3-4 antibiotics for the treatment of NTMLD.1 Based on the type of NTM someone has (e.g. MAC lung disease) their health care provider may recommend the following medicines clarithromycin or azithromycin, rifampin or rifabutin and ethambutol, and possibly streptomycin or amikacin. The treatment guidelines advise that those taking these medicines should stay on them for 12 months after sputum cultures are clear of NTM germs being treated.

Your health care team may suggest that you begin taking the medicines slowly. This may mean that you start the first medicine, then begin the second and third medications one week later. This staggered start will often help those taking the medicines decide whether they are tolerating the treatment.2

Health care teams may closely monitor those that are being treated for NTM lung disease. Those getting treatment for NTM may be asked to return to their physician's office for frequent follow-ups or connect with their health care team regularly. In addition, they may also be asked to have their sputum tested every 1-2 months. This can tell their health care team if the medicines are working and possibly give them an idea of how long treatment may be needed.1 Those taking medicines for the treatment of NTM lung disease will generally need to stay on those medicines for 12 months after the sputum culture is clear of NTM (also known as culture conversion). If the NTM is not responding after 6 months, health care teams may consider additional forms of treatment.1

Health care teams may repeat sputum cultures frequently because research shows that if the sputum culture remains positive for NTM, it can be a sign that the treatment is working properly.3 Most NTM patients who will see a response to the standard multidrug treatment will likely do so within 6 months of the start of treatment.4,5

Potential for side effects. When someone is taking multiple medicines at one time, there is a possibility of having side effects. Those side effects can range from upset stomach and nausea to blurred vision to other symptoms.

According to the 2020 NTM Guidelines, those taking the recommended medications may be monitored in the following ways:

  • Regular visits to an eye doctor
  • Routine lab work to check blood levels (CBC), liver function, and kidney function
  • Regular hearing screening by an audiologist (a health care provider who specializes in hearing)

It can be challenging to be someone with NTM lung disease who must take multiple antibiotics over a long-time span and have multiple medical appointments on an ongoing basis. Many people may feel as though they have not gotten a medical break for a long time. This can be emotionally difficult. If you have NTM lung disease and are struggling with this, know that there are support groups and resources available. Online communities like BronchandNTM360social and NTM Connect allow us to connect and learn from each other. I would encourage you to learn more about your treatment plan, stay on track, monitor for side effects, maintain open communication with your health care team, and make any changes recommended by your physician as needed.


  1. Daley CL, Iaccarino JM, Lange C, et al. Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Clin Infect Dis. 2020;71(4):905-913. doi:10.1093/cid/ciaa1125
  2. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases [published correction appears in Am J Respir Crit Care Med. 2007 Apr 1;175(7):744-5. Dosage error in article text]. Am J Respir Crit Care Med. 2007;175(4):367-416. doi:10.1164/rccm.200604-571ST
  3. Jeong BH, Jeon K, Park HY, et al. Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2015;191(1):96-103. doi:10.1164/rccm.201408-1545OC
  4. Sheng-Wei Pan, Chin-Chung Shu, Jia-Yih Feng, Jann-Yuan Wang, Yu-Jiun Chan, Chong-Jen Yu, Wei-Juin Su, Microbiological Persistence in Patients With Mycobacterium avium Complex Lung Disease: The Predictors and the Impact on Radiographic Progression, Clinical Infectious Diseases, Volume 65, Issue 6, 15 September 2017, Pages 927–934, https://doi.org/10.1093/cid/cix479
  5. Furuuchi K, Morimoto K, Kurashima A, et al. Treatment Duration and Disease Recurrence Following the Successful Treatment of Patients With Mycobacterium avium Complex Lung Disease. Chest. 2020;157(6):1442-1445. doi:10.1016/j.chest.2019.12.016