The treatment of Mycobacterium abscessus lung disease

M. abscessus is a rapid growing non-tubercuous mycobacterium (NTM) which may cause considerable pulmonary morbidity in certain individuals. The disease process is usually an indolent one allowing the physician time to assess the significance of respiratory isolation in individual patients. The indolent nature of the disease process combined with the very difficult and poorly tolerated treatment regimens essentially mandates that both the physician and patient should be convinced of the need for therapy, which will inevitably require significant sacrifices on the patient’s part, including outpatient antibiotic therapy. The choice of therapeutic regimens remains problematic and is discussed with regard to the case presented. Mounting evidence suggests that lung disease due to M. abscessus ssp bolletii (M. massiliense) is considerably more responsive to current therapeutic regimens than disease due to M abscessus ssp abscessus, likely due in no small part to the absence of a functional erm gene in M. abscessus ssp bolletii.