Treatment for Nontuberculous Mycobacterial Lung Disease

Medically Reviewed by Jabeen Begum, MD on May 20, 2021

If you’re diagnosed with nontuberculous mycobacterial lung disease, your doctor will discuss the right treatment for you.

Some people with NTM lung disease don’t need treatment. Others require ongoing treatments to keep their disease under control.

Your doctor may decide to watch and wait rather than treat your infection. They can check your symptoms and look at X-rays to make sure your lungs don’t start to show damage.

Why wouldn’t you want to treat your infection even if it’s mild? You’ll need to take antibiotics. They have side effects. And you’ll probably need more than one type because the bacteria often become resistant to drugs. Your doctor will weigh the pros and cons of treating your disease right away.

If your doctor does choose to treat it, you’ll take the medicine for a while. The doctor will run a sputum culture test every month or two to look for bacteria. You’ll cough up some mucus and they’ll send it to a lab for tests. You can stop taking the meds when the results have come back negative for a year.

Your doctor will decide which antibiotic to try first based on:

  • The exact type of bacteria that caused your infection and how it reacts to different drugs
  • Your age
  • Your symptoms
  • Your overall health
  • Other medications you take
  • How severe your disease seems to be

Most people with an NTM lung infection start with a combination of antibiotics that they take three times a week. You may have to change medications if the bacteria become resistant to your doctor’s first choice, but they have several options to choose from.

Doctors treat mycobacterium avium complex (MAC) disease, the most common NTM lung infection, with a combination of three antibiotics:

If you have more severe MAC disease that results from cavities in your lungs, your doctor may try rifabutin (Mycobutin) instead of rifampin (Rifadin, Rimactane). They might add amikacin or streptomycin three times a week early in your treatment.

If you have HIV, too, you’re at higher risk for disseminated MAC disease. It causes symptoms all over your body like night sweats, weight loss, fever, and anemia. Treatment involves taking two medications. Studies show that using just one medicine is not effective and causes bacterial resistance. You'll be given azithromycin or clarithromycin along with ethambutol. This is called double therapy. If needed, you might also take rifabutin, which is considered triple therapy. 

If you have AIDS and CD4+ T-lymphocyte counts less than 50 cells/microliter, you can try to prevent disseminated MAC disease with azithromycin or clarithromycin. Rifabutin is another option, but it may be harder on your system.

If you’re infection is from M. kansasii bacteria, you’ll probably take a mix of azithromycin, ethambutol, and rifampin once a day for 1 year or until your sputum test is negative.

If you have an M. abscessus lung infection, antibiotics alone may not work. Clarithromycin along with other drugs may help control your symptoms and keep the disease from getting worse. You might need surgery to remove damaged parts of your lung, too.

All antibiotics for NTM lung disease have side effects. They can be hard on your liver or kidneys, cause hearing loss or tinnitus (ringing in your ears), or severe upset stomach.

Your doctor may need to switch your medicines or lower your dose if one medicine causes a serious reaction. If you notice sudden problems with your hearing or eyesight, or pain or numbness in your hands or feet, call them right away.

Antibiotics alone may not clear up your infection or ease your symptoms. Some people also need surgery to take out damaged lung tissue.

Surgery along with antibiotics can clear up an NTM lung infection in many people.

But if you cough up blood after you’ve taken antibiotics, surgery may be a next step.

There are other things you can try to ease your symptoms and help clear up your infection. You don’t do them instead of your medicines, but as an add-on. Talk to your doctor first if you’d like to try any of these therapies:

  • Nebulized hypertonic saline: A machine called a nebulizer sprays sterile, salty water into your airways to help clear mucus from your lungs.
  • High-frequency chest wall oscillation: This device loosens mucus in your lungs.
  • Physical therapy
  • Huff cough, a technique to clear out the gunk

You can also:

Once you treat your NTM lung disease, you can take steps to prevent another infection. These bacteria are often found in water or moist places, so take these easy steps:

  • Avoid hot tubs or spas. If you have a hot tub, make sure it’s outside your house.
  • Don’t use unfiltered tap water in room humidifiers or CPAP machines for sleep apnea.
  • Install a water filtration system in your home.
  • Don’t take long, hot showers.
  • Boil tap water before you drink it.
  • Avoid exposure to smoke and other lung irritants 
  • Maintan vaccinations against flu, pneumonia and COVID-19

Lung disease symptoms and the treatments for them may make you feel awful at times. At any point in your life with lung disease, ask your doctor about palliative care to help you feel more comfortable.

Palliative care is any treatment that helps to ease symptoms or just make you feel better. You may need oxygen therapy to help you breathe more easily, take meds for your upset stomach, or see a counselor to deal with stress.

Counseling or support groups of other people with lung disease can help you manage depression or anxiety. Check out groups in your area or online. Let your doctor know if your lung disease makes you feel depressed or hopeless, so you can get treatment right away.

Show Sources


National Organization for Rare Disorders: “Nontuberculous Mycobacterial Lung Disease.”

Tuberculosis and Respiratory Diseases: “Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease: Clinicians' Perspectives.”

American Lung Association: “Diagnosing and Treating NTM Pulmonary Disease.”

American Journal of Respiratory and Critical Care Medicine: “An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases.”

Morbidity and Mortality Weekly Report: “Recommendations on Prophylaxis and Therapy for Disseminated Mycobacterium Avium Complex for Adults and Adolescents Infected With Human Immunodeficiency Virus.”

American Thoracic Society: “Palliative Care for People With Respiratory Disease or Critical Illness.”

UpToDate: “Treatment of Mycobacterium avium complex lung infection in adultsTreatment of Myobacterium avium lung infection in adults,” “Myobacterium avium complex (MAC) in HIV-infected patients.”complex (MAC) infections in HIV-infected patients."

NTM Info & Research: “Currently Recruiting.”

Medscape. "Mycobacterium Avium Complex (MAC) (Mycobacterium Avium-Intracellulare [MAI]) Treatment & Management."

National Institutes of Health. "Mycobacterium avium Complex Disease."

Journal of Antimicrobial Chemotherapy. "Treatment of Mycobacterium avium–intracellulare complex: a great leap forward."

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