Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review
The Mycobacterium avium complex (MAC), comprising M. avium and M. intracellulare, constitutes the predominant cause of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Korea, followed by the M. abscessus complex. Its global prevalence is increasing, as shown by a marked rise in Korea from...
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Ewha Womans University College of Medicine
2025-04-01
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| Series: | The Ewha Medical Journal |
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| Online Access: | http://www.e-emj.org/upload/pdf/emj-2025-00080.pdf |
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| author | Chiwook Chung |
| author_facet | Chiwook Chung |
| author_sort | Chiwook Chung |
| collection | DOAJ |
| description | The Mycobacterium avium complex (MAC), comprising M. avium and M. intracellulare, constitutes the predominant cause of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Korea, followed by the M. abscessus complex. Its global prevalence is increasing, as shown by a marked rise in Korea from 11.4 to 56.7 per 100,000 individuals between 2010 and 2021, surpassing the incidence of tuberculosis. Among the older adult population (aged ≥65 years), the prevalence escalated from 41.9 to 163.1 per 100,000, accounting for 47.6% of cases by 2021. Treatment should be individualized based on prognostic indicators, including cavitary disease, low body mass index, and positive sputum smears for acid-fast bacilli. Current therapeutic guidelines recommend a 3-drug regimen—consisting of a macrolide, rifampin, and ethambutol—administered for a minimum of 12 months following culture conversion. Nevertheless, treatment success rates are only roughly 60%, and over 30% of patients experience recurrence. This is often attributable to reinfection rather than relapse. Antimicrobial susceptibility testing for clarithromycin and amikacin is essential, as resistance significantly worsens prognosis. Ethambutol plays a crucial role in preventing the development of macrolide resistance, whereas the inclusion of rifampin remains a subject of ongoing debate. Emerging therapeutic strategies suggest daily dosing for milder cases, increased azithromycin dosing, and the substitution of rifampin with clofazimine in severe presentations. Surgical resection achieves a notable sputum conversion rate of approximately 93% in eligible candidates. For refractory MAC-PD, adjunctive therapy with amikacin is advised, coupled with strategies to reduce environmental exposure. Despite advancements in therapeutic approaches, patient outcomes remain suboptimal, highlighting the urgent need for novel interventions. |
| format | Article |
| id | doaj-art-ab8af93fa625408087356fbf866dfe85 |
| institution | Kabale University |
| issn | 2234-3180 2234-2591 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Ewha Womans University College of Medicine |
| record_format | Article |
| series | The Ewha Medical Journal |
| spelling | doaj-art-ab8af93fa625408087356fbf866dfe852025-08-26T00:04:46ZengEwha Womans University College of MedicineThe Ewha Medical Journal2234-31802234-25912025-04-0148210.12771/emj.2025.000801608Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative reviewChiwook Chung0Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, KoreaThe Mycobacterium avium complex (MAC), comprising M. avium and M. intracellulare, constitutes the predominant cause of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Korea, followed by the M. abscessus complex. Its global prevalence is increasing, as shown by a marked rise in Korea from 11.4 to 56.7 per 100,000 individuals between 2010 and 2021, surpassing the incidence of tuberculosis. Among the older adult population (aged ≥65 years), the prevalence escalated from 41.9 to 163.1 per 100,000, accounting for 47.6% of cases by 2021. Treatment should be individualized based on prognostic indicators, including cavitary disease, low body mass index, and positive sputum smears for acid-fast bacilli. Current therapeutic guidelines recommend a 3-drug regimen—consisting of a macrolide, rifampin, and ethambutol—administered for a minimum of 12 months following culture conversion. Nevertheless, treatment success rates are only roughly 60%, and over 30% of patients experience recurrence. This is often attributable to reinfection rather than relapse. Antimicrobial susceptibility testing for clarithromycin and amikacin is essential, as resistance significantly worsens prognosis. Ethambutol plays a crucial role in preventing the development of macrolide resistance, whereas the inclusion of rifampin remains a subject of ongoing debate. Emerging therapeutic strategies suggest daily dosing for milder cases, increased azithromycin dosing, and the substitution of rifampin with clofazimine in severe presentations. Surgical resection achieves a notable sputum conversion rate of approximately 93% in eligible candidates. For refractory MAC-PD, adjunctive therapy with amikacin is advised, coupled with strategies to reduce environmental exposure. Despite advancements in therapeutic approaches, patient outcomes remain suboptimal, highlighting the urgent need for novel interventions.http://www.e-emj.org/upload/pdf/emj-2025-00080.pdfbacterial drug resistanceethambutollung diseases complextuberculosis |
| spellingShingle | Chiwook Chung Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review The Ewha Medical Journal bacterial drug resistance ethambutol lung diseases complex tuberculosis |
| title | Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review |
| title_full | Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review |
| title_fullStr | Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review |
| title_full_unstemmed | Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review |
| title_short | Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review |
| title_sort | current and emerging treatment strategies for mycobacterium avium complex pulmonary disease a narrative review |
| topic | bacterial drug resistance ethambutol lung diseases complex tuberculosis |
| url | http://www.e-emj.org/upload/pdf/emj-2025-00080.pdf |
| work_keys_str_mv | AT chiwookchung currentandemergingtreatmentstrategiesformycobacteriumaviumcomplexpulmonarydiseaseanarrativereview |