@ddoran9233 This is a highly individual decision, and needs to be done in conjunction with your care team, considering all of your medical issues, and the type of NTM you have (while most grow slowly, some like M Abscessus can progress rapidly.) Also, if you have other infections like Pseudomonas, it is preferable to treat them first as they usually are easier to knock down.

In my case, I would take the antibiotics (Big3) again - I had Pseudomonas that had weakened me and took 4 courses of antibiotics to clear, during that time my MAC got worse. My condition was severe, I was coughing non-stop, losing weight, running a fever, had crushing fatigue and could not even walk a block.

IF on the other hand, I was not symptomatic or had few symptoms, and did not have any cavities or large nodules, and knowing what we have all learned these past 8+ years, I would ask to do "active watching and waiting." That would be twice daily airway clearance with 7% saline nebs, regular sputum cultures, and at least twice yearly CT scans. If after 6 months or a year of the conservative treatment, I was getting worse, I would try the antibiotics.

Age and overall physical condition also play a part - if I was in generally poor health and thought I could not tolerate the 3 antibiotic regimen, I would ask to do what we did for my Mom when she was in that situation. We just treated exacerbations as they occurred. When she finally died after several years of declining health, MAC was not her cause of death - it was one of her several other serious health problems.

Are you in the situation of considering antibiotic therapy? Are you working with a care team you trust?