The standard protocol is the Big 3, if the patient can't tolerate the Big 3 or the bacteria aren't susceptible (especially to Azithromycin/Clarithromycin), then they will try another antibiotic. The arsenal of available therapies is very limited, however.

If the patient has nodular MAC and is reasonably stable, they will treat with the Big 3, three days per week.

If the patient has cavitary disease (cavity larger than 2 cm), they will do daily Big 3 treatment. Daily treatment is also used for refractory/stubborn MAC (defined as lack of sputum conversion within first 6 months).

Also, if patient doesn't convert within 6 month on either daily or 3 day per week Big 3, they recommend adding Arikayce. Arikayce is an inhaled liposomal form of Amikacin. Amikacin in IV form is used in cases that are extremely stubborn/severe.

I take the Big 3 all at once, in addition to daily Arikayce.