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Treatment for mycobacterium avium complex (MAC) depends on where the infection is. Your doctor will also consider how serious your symptoms are and other medical conditions you may have. Here’s what you need to know.

When Do You Treat Mycobacterium Avium Complex?

MAC tends to grow slowly. Some infections go away on their own. And it’s not the kind of illness you have to worry about spreading to others.

If you have a mild infection, your doctor may not start treatment right away. That’s partly because medication comes with side effects. Instead, you’ll come in for regular checkups to see how you’re doing. This is called watchful waiting.

Your doctor will go over the pros and cons of the watchful waiting approach. But it’s not right for everyone. Antibiotic therapy is usually the go-to treatment if you have certain X-ray or lab test results.

To figure out how serious your infection is, your doctor will look at your body and ask about symptoms. Then you’ll likely get one or more of the following:

  • Blood test
  • Chest X-ray or CT scan
  • Lymph node or bone marrow biopsy
  • Mucus test (sputum culture)

If you can’t cough up enough mucus, you may need a bronchoscopy. That’s when the doctor looks inside your lungs and airways with a bronchoscope. That’s a thin tube with a camera on the end.

The doctor will decide the best treatment based on what your tests show.

Which Drugs Treat Mycobacterium Avium Complex?

You’ll need to take more than one kind of antibiotic. That’ll lessen the chances of drug resistance. That’s when bacteria keep growing despite treatment.

Antibiotic treatment for MAC infections usually includes a mix of the following:

  • Azithromycin or clarithromycin
  • Ethambutol
  • Rifampin

You’ll take two or more antibiotics for at least 1 year. That’s to make sure all the MAC die. During this time, your doctor will test your blood or mucus every month or so for signs of infection.

Antibiotics may lead to unwanted symptoms. These include:

  • Nausea
  • Diarrhea
  • Belly pain
  • A metallic taste in your mouth

You might also have:

  • Eye issues (with ethambutol)
  • Kidney or urinary problems (with rifampin)
  • Other bacterial infections

Bring up any side effects that make you feel bad. Your doctor may need to change the kind of antibiotic you take.

If you’re an older adult, long-term antibiotic use ups your chances of C. difficile. That’s a bacterial infection that causes serious diarrhea. Tell your doctor if this happens to you. You may need treatment with other antibiotics to get better.

The beginning treatment for MAC tends to be the same for most everyone. But you may need other medication depending on what kind of infection you have. Here’s a breakdown:

Pulmonary MAC infection. If you have a lung infection that doesn’t get better within 6 months, ask your doctor about an antibiotic you breathe in. It’s called amikacin liposome inhalation suspension (Arikayce). Scientists are still studying the long-term safety of this drug.

HIV-related MAC infection. It’s best to start antiretroviral therapy (ART) right away if you haven’t already. You can do this at the same time as your antibiotic treatment. You may still need to take preventive antibiotics for a while, at least until your immune system gets stronger.

What Are Airway Clearance Techniques for Mycobacterium Avium Complex?

MAC affects everyone differently. But most infections impact the lungs. You may not be able to breathe very well if you have lots of bacteria-filled mucus in your airways. And sputum that sticks around can be a breeding ground for other respiratory infections.  

There are steps you can take to clear your lungs. You may hear these called airway clearance techniques (ACTs). Your doctor may strongly suggest ACTs if you also have bronchiectasis, chronic obstructive pulmonary disease (COPD), or another lung disease.  

Here are some ACTs your doctor might want you to try:  

Breathing techniques. A doctor or respiratory therapist can teach you specific breathing patterns. One is called the “huff” technique. You’ll take slow, deep breaths and then exhale with force. The goal is to get air behind your mucus so it’s easier to cough up.

Devices to help you breathe or cough. Your doctor can go over all your choices. But here are some tools you might want to ask about:

  • Cough assist
  • Chest-wall oscillation vest
  • Chest percussion device
  • Nebulizers

Chest physical therapy. A therapist may tap or put pressure on your chest. They’ll have you breathe a certain way at the same time. This can help loosen mucus that sticks in your lungs.

Can Surgery Treat Mycobacterium Avium Complex?

Rarely, you may need a doctor to cut out infected or damaged lung tissue. After surgery, you’ll likely take antibiotics for a little while to kill any MAC left behind.

You or your child may need surgery if you have a MAC-associated lymph node infection. This is called lymphadenitis, and it’s more likely in kids younger than 5. Instead of antibiotic treatment, the doctor may cut out the infected lymph nodes.

Self-Care Tips for Mycobacterium Avium Complex

Antibiotics can get rid of MAC in some cases. But you might have lifelong lung damage even after treatment. If so, there are steps you can take to breathe better and boost your quality of life. Ask your doctor for more tips, but the following may help:  

Keep moving. Exercise can help clear mucus from your lungs. Try to get at least 150 minutes of moderate physical activity a week. For example, you could go for a 30-minute brisk walk, 5 days a week.

Eat a balanced diet. MAC infections can affect your nutrition. Not sure how to eat healthy? Ask your doctor to refer you to a dietitian. They’ll create an eating plan that works for you.  

Avoid smoke. Chemicals in cigarette smoke can bother your lungs.

Get vaccinated. Other respiratory infections can worsen your breathing. Vaccines are the best way to prevent illness from flu, pneumonia, and COVID-19. Ask your doctor if other vaccines are right for you.   

MAC bacteria are all around us. It’s not possible to avoid them. But you can ask your doctor how to prevent future infections and manage your ongoing symptoms. Visit the American Lung Association for more information on how to live with MAC lung disease.

Show Sources

Photo Credit: SDI Productions / Getty Images


Cleveland Clinic: “MAC Lung Disease,” “Nontuberculous Mycobacteria Infections.”

Tuberculosis & Respiratory Diseases: “Treatment of Mycobacterium avium Complex Pulmonary Disease.”

Clinical Infectious Diseases: “Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline.”

UT Health: “Mycobacterium avium intracellulare complex (MAC): Frequently Asked Questions.”

BMC Infectious Diseases: “Analysis of adverse drug events in pulmonary Mycobacterium avium complex disease using spontaneous reporting system.” “Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV.”

Merck Manual: “Nontuberculous Mycobacterial Infections.”

Drug Design, Development and Therapy: “The Use of Amikacin Liposome Inhalation Suspension (Arikayce) in the Treatment of Refractory Nontuberculous Mycobacterial Lung Disease in Adults.”

Frontiers in Medicine: “Airway Clearance Techniques: The Right Choice for the Right Patient.”

American Lung Association: “Treating and Managing  Lung Disease.”