Assessing the need for treatment

Patients with nontuberculous mycobacterial infections should be managed by an expert. Not all cases require treatment; the need for treatment is in part guided by the organism identified.

Mycobacterium fortuitum and Mycobacterium chelonae are more commonly associated with skin and soft tissue infections, while Mycobacterium abscessus is usually a respiratory pathogen but may cause soft tissue and prosthetic material infection. Mycobacterium avium complex infection is usually seen in people with underlying lung disease, or as a bronchiectatic and nodular disease in postmenopausal women.

For respiratory infection, a period of observation and serial imaging is often required to determine the need for treatment. In patients with significant lung disease (eg chronic obstructive pulmonary disease), it may not be clear whether nontuberculous mycobacteria identified in sputum are contributing to symptoms. In these patients, optimise management of the lung disease before determining the need for antibiotics. However, early antibiotic treatment without a period of observation may be appropriate for patients with cavitary disease or a high burden of infection (eg suggested by smear positivity).