Department of Infection, Royal London Hospital, Barts Health NHS Trust.
Barts and the London School of Medicine and Dentistry, Queen Mary University of London.
Curr Opin Pulm Med. 2021 May 1;27(3):216-223. doi: 10.1097/MCP.0000000000000764.
Infections caused by nontuberculous mycobacteria (NTM) are increasing for several reasons, including diagnostic advances, increased awareness and a larger at-risk population. NTM pulmonary disease is surpassing tuberculosis (TB) in some low incidence areas. This review summarizes the latest literature and guidelines and aims to be a concise source outlining treatment and management of NTM lung infections, integrating established treatment paradigms with novel pharmacological interventions.
Recent additions to NTM treatment are inhaled liposomal amikacin and the anti-TB drug bedaquiline. Several other new or repurposed treatments are being explored in vitro, in animal models and in clinical trials, including novel beta-lactamase inhibitor/lactam combinations, dual-lactam combinations, efflux pump inhibitors, novel antimicrobials, inhaled clofazimine suspension and bacteriophages.
Patients with NTM pulmonary disease are mainly female and older with significant delay between diagnosis and treatment being common. Treatment varies according to causative organism, drug susceptibilities, radiological type and disease severity. Underlying chronic conditions, drug intolerances and interactions require careful consideration. In all cases, at least three drugs should be used to minimize acquisition of drug resistance, and all patients should receive a minimum of 12 months of treatment. Expert advice should be taken. NTM treatment is longer than TB treatment, more likely to fail and more likely to cause toxicity. The relatively small numbers of patients affected by each NTM species has limited research. Novel treatments hold promise; nevertheless, it is likely that new solutions for NTM management will stem from the TB pipeline for the foreseeable future.
由于诊断技术进步、人们对该病的认识提高以及高危人群增加等原因，非结核分枝杆菌（NTM）感染呈上升趋势。在一些低发地区，NTM 肺病的发病率已超过结核病（TB）。本综述总结了最新文献和指南，旨在为 NTM 肺部感染的治疗和管理提供一个简洁的资源，将既定的治疗模式与新型药物干预相结合。
NTM 治疗的新进展包括吸入性脂质体硫酸阿米卡星和抗结核药物贝达喹啉。其他几种新的或重新应用的治疗方法正在体外、动物模型和临床试验中进行探索，包括新型β-内酰胺酶抑制剂/β-内酰胺类药物组合、双联β-内酰胺类药物组合、外排泵抑制剂、新型抗菌药物、吸入性氯法齐明混悬液和噬菌体。
NTM 肺病患者主要为女性和老年人，诊断和治疗之间存在明显的延迟。治疗方法因病原体、药敏性、影像学类型和疾病严重程度而异。应仔细考虑潜在的慢性疾病、药物不耐受和相互作用。在所有情况下，至少应使用三种药物以最大限度地减少耐药性的产生，所有患者均应接受至少 12 个月的治疗。应咨询专家意见。NTM 治疗的时间长于 TB 治疗，更有可能失败，且更有可能导致毒性。受每种 NTM 物种影响的患者数量相对较少，限制了相关研究。新型治疗方法前景广阔；然而，在可预见的未来，NTM 管理的新解决方案可能源自 TB 药物研发管线。
