Update On Treatment of MAC

Hello All! I had a vist to the Mayo this past Tues. I was first diagnosed with MAC in 2005. I refused the three drug standard treatment. Several weeks on antibiotics knocked it out. It came back in 2013, was treated with one antibiotic for 10 days a month on a monthly basis. It cleared up. Then in 2016, had pseudomonas infection. It was treated with bi-monthly tobramysin & cipro. It too cleared up.I asked my Dr why in the four yrs I have been going to the Mayo; that he never put me on the BIG THREE antibiotics. His reply, and I quote with his permission: The BIG THREE treatment is 'old school' and it is OVER-TREATING most patients. He said he gets new patients in seeking second opinions and that he takes no less than three people a week OFF of the BIG THREE. I asked what he prescribes instead. He said it varies depending on colony size, specie, patient history, etc. He stated that most drs prescribe the BIG THREE because it was the norm years ago, and they honestly do not know much about the disease. He only uses the BIG THREE when a patient does not respond to single antibiotic treatments, or is SEVERE and CHRONIC. I would guess Katherine may fall into that catagory. He also said that he sometimes doesn't recommend treatment at all because 90% of the time, the MAC clears up on it's own. That may be why someone recently posted she was confused as to why her dr did not want to treat it yet and wait and see. I found this info VERY interesting.

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Profile picture for bee1950 @bee1950

Yes, Mayo takes Medicare!

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Thank You! I will definitely be calling them.....

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Can you share your doctor's name? Is he at Mayo Rochester? I am currently a patient at Mayo Rochester for bronchiectasis, and I was just diagnosed with MAC.

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Profile picture for mtinderscott2626 @mtinderscott2626

Can you share your doctor's name? Is he at Mayo Rochester? I am currently a patient at Mayo Rochester for bronchiectasis, and I was just diagnosed with MAC.

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@mtinderscott2626 Teri (@windwalker) is no longer active on Mayo Connect. Since her post in 2017, Mayo has formed a Bronchiectasis and MAC treatment group, so if you are diagnosed you will be referred to one of them.
As for whether the "Big 3" is old school or not, research-based protocols for treatment of MAC/NTM have been developed. These include watch & wait with daily airway clearance, and several combinations of antibiotics, from two to five drugs at a time, depending on the condition of your lungs, the severity of infection, the specific bacteria (many types of NTM), the antibiotics to which it responds, and what a person can tolerate.

Here is a guide from 2019, but more options have been added since:
https://www.ntminfo.org/wp-content/uploads/2019/09/Guide-for-Patients-with-NTM-Infections-2019-09.pdf
This is somewhat heavy reading, but you can see it here:
https://ntminfo.org/wp-content/uploads/2020/07/NTMguidelines2020.pdf
Here are the 2025 European guidelines, which will likely be adapted and published in the US:
https://publications.ersnet.org/content/erj:::66:::6:::2501126.full.pdf

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Profile picture for Sue, Volunteer Mentor @sueinmn

@mtinderscott2626 Teri (@windwalker) is no longer active on Mayo Connect. Since her post in 2017, Mayo has formed a Bronchiectasis and MAC treatment group, so if you are diagnosed you will be referred to one of them.
As for whether the "Big 3" is old school or not, research-based protocols for treatment of MAC/NTM have been developed. These include watch & wait with daily airway clearance, and several combinations of antibiotics, from two to five drugs at a time, depending on the condition of your lungs, the severity of infection, the specific bacteria (many types of NTM), the antibiotics to which it responds, and what a person can tolerate.

Here is a guide from 2019, but more options have been added since:
https://www.ntminfo.org/wp-content/uploads/2019/09/Guide-for-Patients-with-NTM-Infections-2019-09.pdf
This is somewhat heavy reading, but you can see it here:
https://ntminfo.org/wp-content/uploads/2020/07/NTMguidelines2020.pdf
Here are the 2025 European guidelines, which will likely be adapted and published in the US:
https://publications.ersnet.org/content/erj:::66:::6:::2501126.full.pdf

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@sueinmn
Hi Sue! Been awhile. Happy New Year to you.
-Windwalker (Terri)

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