NTM Pulmonary Disease Guidelines<\/title>\n <style>\n body {\n font-family: 'Segoe UI', Tahoma, Geneva, Verdana, sans-serif;\n line-height: 1.6;\n color: #333;\n max-width: 1200px;\n margin: 0 auto;\n padding: 20px;\n background: linear-gradient(135deg, #667eea 0%, #764ba2 100%);\n min-height: 100vh;\n }\n \n .container {\n background: white;\n border-radius: 15px;\n box-shadow: 0 10px 30px rgba(0,0,0,0.2);\n overflow: hidden;\n }\n \n .header {\n background: linear-gradient(135deg, #2c3e50 0%, #34495e 100%);\n color: white;\n padding: 30px;\n text-align: center;\n }\n \n .header h1 {\n margin: 0;\n font-size: 2.5em;\n font-weight: 300;\n }\n \n .subtitle {\n margin: 10px 0 0 0;\n opacity: 0.8;\n font-size: 1.1em;\n }\n \n .content {\n padding: 30px;\n }\n \n .section {\n margin-bottom: 40px;\n padding: 25px;\n border-radius: 10px;\n box-shadow: 0 4px 15px rgba(0,0,0,0.1);\n }\n \n .epidemiology {\n background: linear-gradient(135deg, #3498db, #2980b9);\n color: white;\n }\n \n .diagnosis {\n background: linear-gradient(135deg, #e74c3c, #c0392b);\n color: white;\n }\n \n .sampling {\n background: linear-gradient(135deg, #27ae60, #229954);\n color: white;\n }\n \n .treatment {\n background: linear-gradient(135deg, #f39c12, #e67e22);\n color: white;\n }\n \n .monitoring {\n background: linear-gradient(135deg, #9b59b6, #8e44ad);\n color: white;\n }\n \n .surgery {\n background: linear-gradient(135deg, #34495e, #2c3e50);\n color: white;\n }\n \n .section h2 {\n margin-top: 0;\n font-size: 1.8em;\n border-bottom: 2px solid rgba(255,255,255,0.3);\n padding-bottom: 10px;\n }\n \n .grid {\n display: grid;\n grid-template-columns: repeat(auto-fit, minmax(300px, 1fr));\n gap: 20px;\n margin-top: 20px;\n }\n \n .card {\n background: rgba(255,255,255,0.1);\n padding: 20px;\n border-radius: 8px;\n border: 1px solid rgba(255,255,255,0.2);\n }\n \n .species-list {\n display: grid;\n grid-template-columns: repeat(2, 1fr);\n gap: 15px;\n margin-top: 15px;\n }\n \n .species-item {\n background: rgba(255,255,255,0.1);\n padding: 10px 15px;\n border-radius: 5px;\n border-left: 4px solid rgba(255,255,255,0.5);\n }\n \n .treatment-table {\n width: 100%;\n border-collapse: collapse;\n margin: 20px 0;\n background: rgba(255,255,255,0.1);\n border-radius: 8px;\n overflow: hidden;\n }\n \n .treatment-table th, .treatment-table td {\n padding: 12px;\n text-align: left;\n border-bottom: 1px solid rgba(255,255,255,0.2);\n }\n \n .treatment-table th {\n background: rgba(255,255,255,0.2);\n font-weight: bold;\n }\n \n .algorithm {\n background: rgba(255,255,255,0.1);\n padding: 20px;\n border-radius: 8px;\n margin: 20px 0;\n text-align: center;\n }\n \n .algorithm-step {\n background: rgba(255,255,255,0.2);\n padding: 15px;\n margin: 10px;\n border-radius: 5px;\n display: inline-block;\n max-width: 200px;\n }\n \n .arrow {\n font-size: 24px;\n color: rgba(255,255,255,0.7);\n margin: 10px 0;\n }\n \n ul, ol {\n padding-left: 20px;\n }\n \n li {\n margin-bottom: 8px;\n }\n \n .highlight {\n background: rgba(255,255,255,0.2);\n padding: 15px;\n border-radius: 5px;\n margin: 15px 0;\n border-left: 4px solid rgba(255,255,255,0.5);\n }\n \n .footer {\n background: #2c3e50;\n color: white;\n padding: 20px;\n text-align: center;\n margin-top: 30px;\n }\n \n @media (max-width: 768px) {\n body {\n padding: 10px;\n }\n \n .content {\n padding: 20px;\n }\n \n .species-list {\n grid-template-columns: 1fr;\n }\n \n .header h1 {\n font-size: 2em;\n }\n }\n <\/style>\n<\/head>\n<body>\n <div class=\"container\">\n <div class=\"header\">\n <p class=\"subtitle\">BTS Guidelines – October 2017 | Dr Swathi Gurajala, MD, FRCPath<\/p>\n <\/div>\n \n <div class=\"content\">\n <div class=\"section epidemiology\">\n <h2>NTM Epidemiology – Relevant Species in UK<\/h2>\n <div class=\"species-list\">\n <div class=\"species-item\"><strong>M. avium complex:<\/strong> 45%<\/div>\n <div class=\"species-item\"><strong>M. malmoense:<\/strong> 22%<\/div>\n <div class=\"species-item\"><strong>M. abscessus:<\/strong> 14%<\/div>\n <div class=\"species-item\"><strong>M. xenopi:<\/strong> 5%<\/div>\n <div class=\"species-item\"><strong>M. kansasii:<\/strong> 4%<\/div>\n <div class=\"species-item\"><strong>M. chelonae:<\/strong> 2.6%<\/div>\n <div class=\"species-item\"><strong>M. simiae:<\/strong> 1.8%<\/div>\n <div class=\"species-item\"><strong>M. fortuitum:<\/strong> 1.8%<\/div>\n <\/div>\n \n <div class=\"highlight\">\n <h3>Possible Causes for Increasing Prevalence:<\/h3>\n <ul>\n <li>Enhanced awareness and improved detection<\/li>\n <li>Reduced incidence of TB<\/li>\n <li>Exposure: showers, reduced hot water temperatures, and soil<\/li>\n <li>Antibiotic exposure creates a favourable niche<\/li>\n <li>Impaired host immunity: ageing, lung disease, drugs<\/li>\n <li>Person-to-person transmission<\/li>\n <\/ul>\n <\/div>\n <\/div>\n \n <div class=\"section diagnosis\">\n <h2>Definition of NTM-Pulmonary Disease<\/h2>\n <p>To determine the clinical relevance of NTM-positive cultures, it is essential to distinguish transient or persistent colonisation from infection. Use of the ATS\/IDSA 2007 definition of NTM-PD is recommended:<\/p>\n \n <div class=\"grid\">\n <div class=\"card\">\n <h3>Clinical Criteria (both required)<\/h3>\n <ol>\n <li>Pulmonary symptoms, nodular or cavitary opacities on chest radiograph, or a high-resolution CT scan that shows multifocal bronchiectasis with multiple small nodules<\/li>\n <li>Appropriate exclusion of other diagnoses<\/li>\n <\/ol>\n <\/div>\n \n <div class=\"card\">\n <h3>Microbiological Criteria (one of following)<\/h3>\n <ol>\n <li>Positive cultures results from at least two separate expectorated sputum samples<\/li>\n <li>Positive culture result from at least one bronchial wash or lavage<\/li>\n <li>Transbronchial or other lung biopsy with mycobacterial histopathological features and positive culture for NTM<\/li>\n <\/ol>\n <\/div>\n <\/div>\n <\/div>\n \n <div class=\"section sampling\">\n <h2>Microbiological Sampling for NTM-PD<\/h2>\n <ul>\n <li><strong>Sample types:<\/strong> Sputum, induced sputum, bronchial washings, bronchoalveolar lavage or transbronchial biopsy samples can be used<\/li>\n <li><strong>Less invasive first:<\/strong> Whenever possible, less invasive sampling should be attempted first to minimise procedural risks<\/li>\n <li><strong>Minimum samples:<\/strong> A minimum of two sputum samples collected on separate days should be sent for mycobacterial culture<\/li>\n <li><strong>CT-directed sampling:<\/strong> For consistently culture-negative sputum samples, CT-directed bronchial washings should be sent for mycobacterial culture<\/li>\n <li><strong>Sputum induction:<\/strong> Should be considered for individuals unable to spontaneously expectorate sputum<\/li>\n <\/ul>\n \n <div class=\"highlight\">\n <h3>Mycobacterial Culture<\/h3>\n <ul>\n <li>All respiratory samples should be stained using auramine-phenol after liquefaction and concentration<\/li>\n <li>Respiratory tract samples should be cultured on solid and liquid media in an ISO15189 accredited clinical laboratory for <strong>8 weeks extending to 12 weeks if necessary<\/strong><\/li>\n <\/ul>\n <\/div>\n <\/div>\n \n <div class=\"section treatment\">\n <h2>Treatment Regimens<\/h2>\n \n <h3>MAC-Pulmonary Disease<\/h3>\n <table class=\"treatment-table\">\n <thead>\n <tr>\n <th>Condition<\/th>\n <th>Treatment<\/th>\n <th>Duration<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td><strong>Non-severe MAC-PD<\/strong><br>(AFB smear negative, no radiological evidence of lung cavitation or severe infection, mild-to-moderate symptoms)<\/td>\n <td>Rifampicin 600mg 3\u00d7\/week + Ethambutol 25mg\/kg 3\u00d7\/week + Azithromycin 500mg 3\u00d7\/week or Clarithromycin 1g 2\u00d7\/week<\/td>\n <td>Minimum 12 months after culture conversion<\/td>\n <\/tr>\n <tr>\n <td><strong>Severe MAC-PD<\/strong><br>(AFB smear positive, radiological evidence of lung cavitation\/severe infection, severe symptoms)<\/td>\n <td>Rifampicin 600mg daily + Ethambutol 15mg\/kg daily + Azithromycin 250mg daily or Clarithromycin 500mg 2\u00d7daily + Consider IV amikacin<\/td>\n <td>Minimum 12 months after culture conversion<\/td>\n <\/tr>\n <tr>\n <td><strong>Clarithromycin-resistant MAC<\/strong><\/td>\n <td>Rifampicin 600mg daily + Ethambutol 15mg\/kg daily + Isoniazid 300mg + pyridoxine 10mg daily or moxifloxacin 400mg daily + Consider IV amikacin<\/td>\n <td>Minimum 12 months after culture conversion<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n \n <h3>M. kansasii-Pulmonary Disease<\/h3>\n <table class=\"treatment-table\">\n <thead>\n <tr>\n <th>Condition<\/th>\n <th>Treatment<\/th>\n <th>Duration<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td><strong>Rifampicin-sensitive M. kansasii<\/strong><\/td>\n <td>Rifampicin 600mg daily + Ethambutol 15mg\/kg daily + Isoniazid 300mg with pyridoxine 10mg daily or Azithromycin 250mg daily or clarithromycin 500mg 2\u00d7daily<\/td>\n <td>Minimum 12 months after culture conversion<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n \n <h3>M. malmoense & M. xenopi<\/h3>\n <div class=\"highlight\">\n <p>Similar treatment regimens to MAC with rifampicin, ethambutol, and clarithromycin\/azithromycin. For severe disease, consider addition of IV amikacin and moxifloxacin\/isoniazid.<\/p>\n <\/div>\n \n <h3>M. abscessus<\/h3>\n <div class=\"highlight\">\n <p><strong>Complex multi-drug regimen requiring specialist management:<\/strong><\/p>\n <ul>\n <li><strong>Initial phase (\u22651 month):<\/strong> IV amikacin + IV tigecycline \u00b1 IV imipenem + oral clarithromycin<\/li>\n <li><strong>Continuation phase:<\/strong> Nebulised amikacin + 2-4 oral antibiotics guided by susceptibility<\/li>\n <li>Duration of IV therapy: 3-6 months may be most appropriate for those who can tolerate it<\/li>\n <\/ul>\n <\/div>\n <\/div>\n \n <div class=\"section monitoring\">\n <h2>Treatment Monitoring & Assessment<\/h2>\n \n <div class=\"grid\">\n <div class=\"card\">\n <h3>Microbiological Response<\/h3>\n <ul>\n <li>Sputum samples for culture every 4-12 weeks during treatment<\/li>\n <li>For 12 months after completing treatment<\/li>\n <li>CT-directed bronchial wash if doubt about persisting infection<\/li>\n <\/ul>\n <\/div>\n \n <div class=\"card\">\n <h3>Radiological Response<\/h3>\n <ul>\n <li>CT scan before starting treatment<\/li>\n <li>CT scan at end of treatment<\/li>\n <li>Document radiological response<\/li>\n <\/ul>\n <\/div>\n \n <div class=\"card\">\n <h3>Clinical Response<\/h3>\n <ul>\n <li>Detailed assessment of pulmonary and systemic symptoms<\/li>\n <li>Record at each clinical review<\/li>\n <li>Monitor treatment tolerance<\/li>\n <\/ul>\n <\/div>\n \n <div class=\"card\">\n <h3>Drug Monitoring<\/h3>\n <ul>\n <li>Therapeutic drug monitoring not routine except for aminoglycosides<\/li>\n <li>Monitor serum levels and creatinine for aminoglycosides<\/li>\n <li>Consider in cases of malabsorption or drug interactions<\/li>\n <\/ul>\n <\/div>\n <\/div>\n <\/div>\n \n <div class=\"section surgery\">\n <h2>Role of Thoracic Surgery & Lung Transplantation<\/h2>\n \n <h3>Thoracic Surgery<\/h3>\n <ul>\n <li>Should be considered at time of diagnosis and revisited in individuals who develop refractory disease<\/li>\n <li>May be indicated for individuals with localised areas of severe disease<\/li>\n <li>Should only be performed following expert multidisciplinary assessment<\/li>\n <li>Patients should be established on antibiotic treatment prior to surgery<\/li>\n <li>Continue treatment for 12 months after culture conversion<\/li>\n <\/ul>\n \n <h3>Lung Transplantation<\/h3>\n <ul>\n <li>Individuals being considered should be assessed for evidence of NTM-pulmonary disease<\/li>\n <li>Potential candidates should be treated whenever possible prior to listing<\/li>\n <li>High post-operative risk of developing invasive and disseminated NTM disease<\/li>\n <li>Progressive NTM-pulmonary disease despite optimal antibiotic therapy likely contraindication to listing<\/li>\n <\/ul>\n <\/div>\n \n <div class=\"section diagnosis\">\n <h2>Decision to Treat<\/h2>\n <div class=\"highlight\">\n <p>The decision should be influenced by:<\/p>\n <ul>\n <li>Severity of NTM-pulmonary disease<\/li>\n <li>Risk of progressive NTM-pulmonary disease<\/li>\n <li>Presence of comorbidity<\/li>\n <li>Goals of treatment<\/li>\n <li>Views of the affected individual on potential risks and benefits<\/li>\n <\/ul>\n <p><strong>Note:<\/strong> Individuals may require a period of longitudinal assessment (symptoms, radiological change and mycobacterial culture results) to inform NTM treatment decisions.<\/p>\n <\/div>\n <\/div>\n <\/div>\n \n <div class=\"footer\">\n <p><strong>Source:<\/strong> BTS Guidelines for the Management of Non-Tuberculous Mycobacterial Pulmonary Disease<\/p>\n <p>October 2017 | Author: Dr Swathi Gurajala, MBBS, MD (Med Micro), FIID (Aus), FRCPath (UK)<\/p>\n <p><a href=\"https:\/\/www.brit-thoracic.org.uk\/document-library\/guidelines\/ntm\/bts-guideline-for-themanagement-of-non-tuberculous-mycobacterial-pulmonary-disease\/\" style=\"color: #ecf0f1;\">View Full Guidelines<\/a><\/p>\n <\/div>\n <\/div>\n<\/body>\n<\/html>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>(Academic purpose only. If you need clinical advice, please speak to your doctor.) NTM Pulmonary Disease Guidelines BTS Guidelines – […]<\/p>\n","protected":false},"author":1,"featured_media":1076,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[36],"tags":[134,209,207],"class_list":["post-1074","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bacteria","tag-guideline","tag-mycobacteria","tag-ntm"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1074","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1074"}],"version-history":[{"count":3,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1074\/revisions"}],"predecessor-version":[{"id":1078,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1074\/revisions\/1078"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/media\/1076"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1074"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1074"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1074"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

{"id":1074,"date":"2025-06-23T23:38:29","date_gmt":"2025-06-23T22:38:29","guid":{"rendered":"https:\/\/microregistrar.com\/?p=1074"},"modified":"2025-06-23T23:49:40","modified_gmt":"2025-06-23T22:49:40","slug":"ntm-pulmonary-disease-guidelines","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=1074","title":{"rendered":"NTM Pulmonary Disease Guidelines"},"content":{"rendered":"\n

(Academic purpose only. If you need clinical advice, please speak to your doctor.)<\/p>\n\n\n\n\n\n\n \n \n NTM Pulmonary Disease Guidelines<\/title>\n <style>\n body {\n font-family: 'Segoe UI', Tahoma, Geneva, Verdana, sans-serif;\n line-height: 1.6;\n color: #333;\n max-width: 1200px;\n margin: 0 auto;\n padding: 20px;\n background: linear-gradient(135deg, #667eea 0%, #764ba2 100%);\n min-height: 100vh;\n }\n \n .container {\n background: white;\n border-radius: 15px;\n box-shadow: 0 10px 30px rgba(0,0,0,0.2);\n overflow: hidden;\n }\n \n .header {\n background: linear-gradient(135deg, #2c3e50 0%, #34495e 100%);\n color: white;\n padding: 30px;\n text-align: center;\n }\n \n .header h1 {\n margin: 0;\n font-size: 2.5em;\n font-weight: 300;\n }\n \n .subtitle {\n margin: 10px 0 0 0;\n opacity: 0.8;\n font-size: 1.1em;\n }\n \n .content {\n padding: 30px;\n }\n \n .section {\n margin-bottom: 40px;\n padding: 25px;\n border-radius: 10px;\n box-shadow: 0 4px 15px rgba(0,0,0,0.1);\n }\n \n .epidemiology {\n background: linear-gradient(135deg, #3498db, #2980b9);\n color: white;\n }\n \n .diagnosis {\n background: linear-gradient(135deg, #e74c3c, #c0392b);\n color: white;\n }\n \n .sampling {\n background: linear-gradient(135deg, #27ae60, #229954);\n color: white;\n }\n \n .treatment {\n background: linear-gradient(135deg, #f39c12, #e67e22);\n color: white;\n }\n \n .monitoring {\n background: linear-gradient(135deg, #9b59b6, #8e44ad);\n color: white;\n }\n \n .surgery {\n background: linear-gradient(135deg, #34495e, #2c3e50);\n color: white;\n }\n \n .section h2 {\n margin-top: 0;\n font-size: 1.8em;\n border-bottom: 2px solid rgba(255,255,255,0.3);\n padding-bottom: 10px;\n }\n \n .grid {\n display: grid;\n grid-template-columns: repeat(auto-fit, minmax(300px, 1fr));\n gap: 20px;\n margin-top: 20px;\n }\n \n .card {\n background: rgba(255,255,255,0.1);\n padding: 20px;\n border-radius: 8px;\n border: 1px solid rgba(255,255,255,0.2);\n }\n \n .species-list {\n display: grid;\n grid-template-columns: repeat(2, 1fr);\n gap: 15px;\n margin-top: 15px;\n }\n \n .species-item {\n background: rgba(255,255,255,0.1);\n padding: 10px 15px;\n border-radius: 5px;\n border-left: 4px solid rgba(255,255,255,0.5);\n }\n \n .treatment-table {\n width: 100%;\n border-collapse: collapse;\n margin: 20px 0;\n background: rgba(255,255,255,0.1);\n border-radius: 8px;\n overflow: hidden;\n }\n \n .treatment-table th, .treatment-table td {\n padding: 12px;\n text-align: left;\n border-bottom: 1px solid rgba(255,255,255,0.2);\n }\n \n .treatment-table th {\n background: rgba(255,255,255,0.2);\n font-weight: bold;\n }\n \n .algorithm {\n background: rgba(255,255,255,0.1);\n padding: 20px;\n border-radius: 8px;\n margin: 20px 0;\n text-align: center;\n }\n \n .algorithm-step {\n background: rgba(255,255,255,0.2);\n padding: 15px;\n margin: 10px;\n border-radius: 5px;\n display: inline-block;\n max-width: 200px;\n }\n \n .arrow {\n font-size: 24px;\n color: rgba(255,255,255,0.7);\n margin: 10px 0;\n }\n \n ul, ol {\n padding-left: 20px;\n }\n \n li {\n margin-bottom: 8px;\n }\n \n .highlight {\n background: rgba(255,255,255,0.2);\n padding: 15px;\n border-radius: 5px;\n margin: 15px 0;\n border-left: 4px solid rgba(255,255,255,0.5);\n }\n \n .footer {\n background: #2c3e50;\n color: white;\n padding: 20px;\n text-align: center;\n margin-top: 30px;\n }\n \n @media (max-width: 768px) {\n body {\n padding: 10px;\n }\n \n .content {\n padding: 20px;\n }\n \n .species-list {\n grid-template-columns: 1fr;\n }\n \n .header h1 {\n font-size: 2em;\n }\n }\n <\/style>\n<\/head>\n<body>\n <div class=\"container\">\n <div class=\"header\">\n <p class=\"subtitle\">BTS Guidelines – October 2017 | Dr Swathi Gurajala, MD, FRCPath<\/p>\n <\/div>\n \n <div class=\"content\">\n <div class=\"section epidemiology\">\n <h2>NTM Epidemiology – Relevant Species in UK<\/h2>\n <div class=\"species-list\">\n <div class=\"species-item\"><strong>M. avium complex:<\/strong> 45%<\/div>\n <div class=\"species-item\"><strong>M. malmoense:<\/strong> 22%<\/div>\n <div class=\"species-item\"><strong>M. abscessus:<\/strong> 14%<\/div>\n <div class=\"species-item\"><strong>M. xenopi:<\/strong> 5%<\/div>\n <div class=\"species-item\"><strong>M. kansasii:<\/strong> 4%<\/div>\n <div class=\"species-item\"><strong>M. chelonae:<\/strong> 2.6%<\/div>\n <div class=\"species-item\"><strong>M. simiae:<\/strong> 1.8%<\/div>\n <div class=\"species-item\"><strong>M. fortuitum:<\/strong> 1.8%<\/div>\n <\/div>\n \n <div class=\"highlight\">\n <h3>Possible Causes for Increasing Prevalence:<\/h3>\n <ul>\n <li>Enhanced awareness and improved detection<\/li>\n <li>Reduced incidence of TB<\/li>\n <li>Exposure: showers, reduced hot water temperatures, and soil<\/li>\n <li>Antibiotic exposure creates a favourable niche<\/li>\n <li>Impaired host immunity: ageing, lung disease, drugs<\/li>\n <li>Person-to-person transmission<\/li>\n <\/ul>\n <\/div>\n <\/div>\n \n <div class=\"section diagnosis\">\n <h2>Definition of NTM-Pulmonary Disease<\/h2>\n <p>To determine the clinical relevance of NTM-positive cultures, it is essential to distinguish transient or persistent colonisation from infection. Use of the ATS\/IDSA 2007 definition of NTM-PD is recommended:<\/p>\n \n <div class=\"grid\">\n <div class=\"card\">\n <h3>Clinical Criteria (both required)<\/h3>\n <ol>\n <li>Pulmonary symptoms, nodular or cavitary opacities on chest radiograph, or a high-resolution CT scan that shows multifocal bronchiectasis with multiple small nodules<\/li>\n <li>Appropriate exclusion of other diagnoses<\/li>\n <\/ol>\n <\/div>\n \n <div class=\"card\">\n <h3>Microbiological Criteria (one of following)<\/h3>\n <ol>\n <li>Positive cultures results from at least two separate expectorated sputum samples<\/li>\n <li>Positive culture result from at least one bronchial wash or lavage<\/li>\n <li>Transbronchial or other lung biopsy with mycobacterial histopathological features and positive culture for NTM<\/li>\n <\/ol>\n <\/div>\n <\/div>\n <\/div>\n \n <div class=\"section sampling\">\n <h2>Microbiological Sampling for NTM-PD<\/h2>\n <ul>\n <li><strong>Sample types:<\/strong> Sputum, induced sputum, bronchial washings, bronchoalveolar lavage or transbronchial biopsy samples can be used<\/li>\n <li><strong>Less invasive first:<\/strong> Whenever possible, less invasive sampling should be attempted first to minimise procedural risks<\/li>\n <li><strong>Minimum samples:<\/strong> A minimum of two sputum samples collected on separate days should be sent for mycobacterial culture<\/li>\n <li><strong>CT-directed sampling:<\/strong> For consistently culture-negative sputum samples, CT-directed bronchial washings should be sent for mycobacterial culture<\/li>\n <li><strong>Sputum induction:<\/strong> Should be considered for individuals unable to spontaneously expectorate sputum<\/li>\n <\/ul>\n \n <div class=\"highlight\">\n <h3>Mycobacterial Culture<\/h3>\n <ul>\n <li>All respiratory samples should be stained using auramine-phenol after liquefaction and concentration<\/li>\n <li>Respiratory tract samples should be cultured on solid and liquid media in an ISO15189 accredited clinical laboratory for <strong>8 weeks extending to 12 weeks if necessary<\/strong><\/li>\n <\/ul>\n <\/div>\n <\/div>\n \n <div class=\"section treatment\">\n <h2>Treatment Regimens<\/h2>\n \n <h3>MAC-Pulmonary Disease<\/h3>\n <table class=\"treatment-table\">\n <thead>\n <tr>\n <th>Condition<\/th>\n <th>Treatment<\/th>\n <th>Duration<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td><strong>Non-severe MAC-PD<\/strong><br>(AFB smear negative, no radiological evidence of lung cavitation or severe infection, mild-to-moderate symptoms)<\/td>\n <td>Rifampicin 600mg 3\u00d7\/week + Ethambutol 25mg\/kg 3\u00d7\/week + Azithromycin 500mg 3\u00d7\/week or Clarithromycin 1g 2\u00d7\/week<\/td>\n <td>Minimum 12 months after culture conversion<\/td>\n <\/tr>\n <tr>\n <td><strong>Severe MAC-PD<\/strong><br>(AFB smear positive, radiological evidence of lung cavitation\/severe infection, severe symptoms)<\/td>\n <td>Rifampicin 600mg daily + Ethambutol 15mg\/kg daily + Azithromycin 250mg daily or Clarithromycin 500mg 2\u00d7daily + Consider IV amikacin<\/td>\n <td>Minimum 12 months after culture conversion<\/td>\n <\/tr>\n <tr>\n <td><strong>Clarithromycin-resistant MAC<\/strong><\/td>\n <td>Rifampicin 600mg daily + Ethambutol 15mg\/kg daily + Isoniazid 300mg + pyridoxine 10mg daily or moxifloxacin 400mg daily + Consider IV amikacin<\/td>\n <td>Minimum 12 months after culture conversion<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n \n <h3>M. kansasii-Pulmonary Disease<\/h3>\n <table class=\"treatment-table\">\n <thead>\n <tr>\n <th>Condition<\/th>\n <th>Treatment<\/th>\n <th>Duration<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td><strong>Rifampicin-sensitive M. kansasii<\/strong><\/td>\n <td>Rifampicin 600mg daily + Ethambutol 15mg\/kg daily + Isoniazid 300mg with pyridoxine 10mg daily or Azithromycin 250mg daily or clarithromycin 500mg 2\u00d7daily<\/td>\n <td>Minimum 12 months after culture conversion<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n \n <h3>M. malmoense & M. xenopi<\/h3>\n <div class=\"highlight\">\n <p>Similar treatment regimens to MAC with rifampicin, ethambutol, and clarithromycin\/azithromycin. For severe disease, consider addition of IV amikacin and moxifloxacin\/isoniazid.<\/p>\n <\/div>\n \n <h3>M. abscessus<\/h3>\n <div class=\"highlight\">\n <p><strong>Complex multi-drug regimen requiring specialist management:<\/strong><\/p>\n <ul>\n <li><strong>Initial phase (\u22651 month):<\/strong> IV amikacin + IV tigecycline \u00b1 IV imipenem + oral clarithromycin<\/li>\n <li><strong>Continuation phase:<\/strong> Nebulised amikacin + 2-4 oral antibiotics guided by susceptibility<\/li>\n <li>Duration of IV therapy: 3-6 months may be most appropriate for those who can tolerate it<\/li>\n <\/ul>\n <\/div>\n <\/div>\n \n <div class=\"section monitoring\">\n <h2>Treatment Monitoring & Assessment<\/h2>\n \n <div class=\"grid\">\n <div class=\"card\">\n <h3>Microbiological Response<\/h3>\n <ul>\n <li>Sputum samples for culture every 4-12 weeks during treatment<\/li>\n <li>For 12 months after completing treatment<\/li>\n <li>CT-directed bronchial wash if doubt about persisting infection<\/li>\n <\/ul>\n <\/div>\n \n <div class=\"card\">\n <h3>Radiological Response<\/h3>\n <ul>\n <li>CT scan before starting treatment<\/li>\n <li>CT scan at end of treatment<\/li>\n <li>Document radiological response<\/li>\n <\/ul>\n <\/div>\n \n <div class=\"card\">\n <h3>Clinical Response<\/h3>\n <ul>\n <li>Detailed assessment of pulmonary and systemic symptoms<\/li>\n <li>Record at each clinical review<\/li>\n <li>Monitor treatment tolerance<\/li>\n <\/ul>\n <\/div>\n \n <div class=\"card\">\n <h3>Drug Monitoring<\/h3>\n <ul>\n <li>Therapeutic drug monitoring not routine except for aminoglycosides<\/li>\n <li>Monitor serum levels and creatinine for aminoglycosides<\/li>\n <li>Consider in cases of malabsorption or drug interactions<\/li>\n <\/ul>\n <\/div>\n <\/div>\n <\/div>\n \n <div class=\"section surgery\">\n <h2>Role of Thoracic Surgery & Lung Transplantation<\/h2>\n \n <h3>Thoracic Surgery<\/h3>\n <ul>\n <li>Should be considered at time of diagnosis and revisited in individuals who develop refractory disease<\/li>\n <li>May be indicated for individuals with localised areas of severe disease<\/li>\n <li>Should only be performed following expert multidisciplinary assessment<\/li>\n <li>Patients should be established on antibiotic treatment prior to surgery<\/li>\n <li>Continue treatment for 12 months after culture conversion<\/li>\n <\/ul>\n \n <h3>Lung Transplantation<\/h3>\n <ul>\n <li>Individuals being considered should be assessed for evidence of NTM-pulmonary disease<\/li>\n <li>Potential candidates should be treated whenever possible prior to listing<\/li>\n <li>High post-operative risk of developing invasive and disseminated NTM disease<\/li>\n <li>Progressive NTM-pulmonary disease despite optimal antibiotic therapy likely contraindication to listing<\/li>\n <\/ul>\n <\/div>\n \n <div class=\"section diagnosis\">\n <h2>Decision to Treat<\/h2>\n <div class=\"highlight\">\n <p>The decision should be influenced by:<\/p>\n <ul>\n <li>Severity of NTM-pulmonary disease<\/li>\n <li>Risk of progressive NTM-pulmonary disease<\/li>\n <li>Presence of comorbidity<\/li>\n <li>Goals of treatment<\/li>\n <li>Views of the affected individual on potential risks and benefits<\/li>\n <\/ul>\n <p><strong>Note:<\/strong> Individuals may require a period of longitudinal assessment (symptoms, radiological change and mycobacterial culture results) to inform NTM treatment decisions.<\/p>\n <\/div>\n <\/div>\n <\/div>\n \n <div class=\"footer\">\n <p><strong>Source:<\/strong> BTS Guidelines for the Management of Non-Tuberculous Mycobacterial Pulmonary Disease<\/p>\n <p>October 2017 | Author: Dr Swathi Gurajala, MBBS, MD (Med Micro), FIID (Aus), FRCPath (UK)<\/p>\n <p><a href=\"https:\/\/www.brit-thoracic.org.uk\/document-library\/guidelines\/ntm\/bts-guideline-for-themanagement-of-non-tuberculous-mycobacterial-pulmonary-disease\/\" style=\"color: #ecf0f1;\">View Full Guidelines<\/a><\/p>\n <\/div>\n <\/div>\n<\/body>\n<\/html>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>(Academic purpose only. If you need clinical advice, please speak to your doctor.) NTM Pulmonary Disease Guidelines BTS Guidelines – […]<\/p>\n","protected":false},"author":1,"featured_media":1076,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[36],"tags":[134,209,207],"class_list":["post-1074","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-bacteria","tag-guideline","tag-mycobacteria","tag-ntm"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1074","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1074"}],"version-history":[{"count":3,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1074\/revisions"}],"predecessor-version":[{"id":1078,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/1074\/revisions\/1078"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/media\/1076"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1074"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1074"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1074"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}