Arikayce (or Amikacin) is a pretty big gun. I personally would reserve it in case the other antibiotics do not work, it can always be added later. Is the doctor talking about 3X/week or daily meds? I found the side effects of daily meds too much to tolerate. Again, these are choices that can be changed as treatment progresses - if 3X/week doesn't shrink the cavity, the doc can increase to daily.

Is your doc a MAC and/or Bronchiectasis specialist?
Sue

Per NTM treatment guidelines and FDA recommendation, Arikayce is only recommended in the case of refractory disease. Refractory/stubborn NTM is defined as lack of sputum conversion after at least 6 months on standard treatment (Big 3). I just started on Arikayce after 10 months of standard treatment (with only one month negative). On the plus side, my cavity did shrink by almost 50% after 7 months of 3 x week Big 3 treatment.

I know this is an old post, but I just found out I have mac and I have a cavity and I'm wondering what you ever decided to do and if it worked for you? If you're still on here can you please respond. I'm really scared

I have a 3.7 CM cavity. I had woke up in January coughing up blood. I have been on azithromycin and ethambutol everyday. I have not been on rifampin because it will lessen the effect of another drug I take. I just had a CT scan done a month ago, it's been about 3 months since I've been on the antibiotics. All of the consolidation and nodules have cleared up and the walls of the cavity went from 15 mm to 5. I just started the Airakayce a couple weeks ago. I have not had any side effects at all. I haven't had any side effects with any of this. I don't cough I can breathe fine. I went and saw an allergist and she ran so many tests and all of them came back negative, I had a pulmonary test done and they said mild obstruction from probably smoking but she said it was so mild that it actually would be in the normal range had they not ever known I smoked. There doesn't seem to be a lot of rhyme or reason why I got this. But I decided to take the airkayce because I have the cavity and because I couldn't be on the third drug that people with cavitery Mac should be on. I think most people take it when they're not responding to other drugs and honestly I don't even know if I'm doing the right thing. I'm just doing what my doctors telling me to though and as long as I'm not having any horrible side effects I would rather do what I can so it doesn't get worse or the cavity doesn't get larger, etc. It has to be a personal choice though. I will say being on the nebulizer is a bit of a pain though.. it's a process that takes about 40 minutes every day. I really hope the results will be worth it though. Good luck with everything. You can always increase the drugs or decrease them depending on how you're feeling and what's working or not working for you.
Angela