Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline

Abstract

Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus infection) caused by the most common NTM pathogens such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among the slowly growing NTM and Mycobacterium abscessus among the rapidly growing NTM. A panel of experts was carefully selected by leading international respiratory medicine and infectious diseases societies (ATS, ERS, ESCMID, IDSA) and included specialists in pulmonary medicine, infectious diseases and clinical microbiology, laboratory medicine, and patient advocacy. Systematic reviews were conducted around each of 22 PICO (Population, Intervention, Comparator, Outcome) questions and the recommendations were formulated, written, and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one evidence-based recommendations about treatment of NTM pulmonary disease are provided. This guideline is intended for use by healthcare professionals who care for patients with NTM pulmonary disease, including specialists in infectious diseases and pulmonary diseases.

Conflict of interest statement

Conflict of interest: C.L. Daley served on advisory committees for Cipla, Horizon, Insmed, Johnson & Johnson, Matinas Biopharma, Otsuka America Pharmaceutical, Paratek, and Spero; received research support from Beyond Air, Insmed, and Spero; served as a consultant for Meiji. Conflict of interest: J.M. Iaccarino has nothing to disclose. Conflict of interest: C. Lange served as a speaker for Berlin Chemie, Chiesi, Gilead, Janssen, Lucane, and Novartis; served on an advisory committee for Oxford Immunotec. Conflict of interest: E. Cambau has nothing to disclose. Conflict of interest: R.J. Wallace Jr served as the director of a university clinical laboratory that does NTM identification, molecular strain comparison, and susceptibility testing; received research support from Insmed as mycobacterial reference laboratory for a trial of the inhaled liposomal amikacin. Conflict of interest: C. Andrejak received research support from Insmed. Conflict of interest: E.C. Böttger served as a consultant for AID Diagnostika, Becton Dickinson, and COPAN; provided expert testimony for Shuttleworth & Ingersoll law firm. Conflict of interest: J. Brozek has nothing to disclose. Conflict of interest: D.E. Griffith served on an advisory committee, as a consultant, as a speaker and received research support from Insmed; served as a consultant for Johnson & Johnson, Merck, and Spero. Conflict of interest: L. Guglielmetti has nothing to disclose. Conflict of interest: G.A. Huitt served on an advisory committee for Hill-Rom and Insmed. Conflict of interest: S.L. Knight has nothing to disclose. Conflict of interest: P. Leitman served as the president of NTM Info & Research, Inc, during which time the organization received support from Insmed, Grifols, BeyondAir, Aradigm, Spero Therapeutics, Johnson & Johnson, Hill-Rom, International Biophysics, Electromed, RespirTech, Maxor Specialty Pharmacy, PantherX, and Kroger Specialty Pharmacy. Conflict of interest: T.K. Marras served as a consultant and received research support from Insmed; served as a speaker for AstraZeneca and Novartis; served as a consultant for Horizon, Spero, and RedHill Biopharma. Conflict of interest: K.N. Olivier received research support from AIT Therapeutics, Insmed, and Matinas Biopharma. Conflict of interest: M. Santin received personal fees from DiaSorin SPA and Vircell SL. Conflict of interest: J.E. Stout has nothing to disclose. Conflict of interest: E. Tortoli has nothing to disclose. Conflict of interest: J. van Ingen served on an advisory committee and as a consultant for Insmed; served on advisory committees for Janssen Pharmaceuticals and Spero. Conflict of interest: D. Wagner served as a speaker for Cepheid GmbH; received research support and travel expenses from Insmed. Conflict of interest: K.L. Winthrop served on an advisory committee for Insmed, Johnson and Johnson, Paratek, Redhill Biopharma, and Spero; served as a consultant for Bayer Healthcare, Bristol-Myers Squibb, Horizon, Lilly, Pfizer, and RedHill Biopharma; received research support from Bristol-Myers Squibb, Cellestis, and Insmed; served on data safety and monitoring boards for Abbvie, Biomarin, Gilead, Roche, and UCB.

Copyright © The Author(s) 2020. This version published by the European Respiratory Society in the European Respiratory Journal, and jointly with Clinical Infectious Diseases. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.