Nontuberculous Mycobacteria Pulmonary Infection in Children with Cystic Fibrosis

As children and adolescents with cystic fibrosis (CF) have lived longer, they have become more susceptible to pulmonary infection with nontuberculous mycobacteria (NTM). Most NTM infections are caused by the Mycobacterium avium complex (MAC) or Mycobacterium abscessus. We review what is currently known and recommended for treatment of these infections.

Treatment of MAC infection is standardized and evidence-based, involving a combination of three oral drugs for 12 months. Treatment of M. abscessus infections is more difficult and not standardized owing to the: lack of bactericidal drugs; variability of drug susceptibilities; inability of in vitro antibiotic susceptibility testing to predict clinical success; lack of randomized trial data to guide therapy; need for initial parenteral therapy; higher rate of adverse reactions to the necessary medications; and high cost and limited availability of some of the drugs. Treatment involves an initial several month period including one or more parenteral antibiotics followed by a prolonged continuation phase using several of the best available oral antibiotics. Dual beta-lactam antibiotic and phage therapies offer some hope for improved outcomes in refractory cases.

The goals for therapy of M. abscessus infections should be considered prior to the onset of treatment, and often are aimed toward improvement in symptoms and quality of life rather that eradication of the organism.