Hello, and welcome to Mayo Connect. As you may already have seen, both MAC and pseudomonas are very big topics of discussion here.
I am sorry to hear that your Dad is suffering from so many serious lung issues. But I am happy that you are taking an active role in his health care. You provided a great summary of what is going on. I'm going to talk a little about MAC, pseudomonas & aspergillus, and then ask a few more questions.
First, all three of these infections are "opportunists" – they are pretty much everywhere, and most of us harbor some of the bacteria in our body without noticeable effect. (Don't worry they are not contagious to those around you.) BUT, for anyone with lung issues like COPD, asthma & fibrosis, they prey on our weakened bodies, especially taking up residence in our damaged lungs. Diseased lungs cannot eject the bacteria through normal lung action like a healthy lung can. This becomes even more of a problem when an oxygen concentrator or CPAP are used, if they are kept meticulously clean, they can also harbor bacteria.
Second, the story of numerous antibiotics, knocking down the infections, but never knocking them out is familiar to many of us. Each of these separate bugs needs to be treated with different antibiotics. Due to their prevalence in people with lung issues, many have become resistant to usual antibiotics and require either combinations or IV antibiotics.
Pseudomonas & Aspergillus have relatively short treatment periods – a few weeks each, but I am not sure of both can be treated at the same time. These also grow much more quickly than MAC bacteria, so are generally treated first, with a goal of eradication, before potential treatment for MAC. Each can be treated with oral, IV or inhaled antibiotics, or a combination of them.
On to MAC – Mycobacteria Avium Complex – it can have many strains, some of which are not harmful to humans, and may not be treated, most of the treatable ones are slow-growing and each responds to a different multi-drug routine. One, M. Abscessus, is more virulent and needs quicker treatment. MAC is diagnosed by taking the original sputum specimin and growing it in culture in a specialized lab to determine if it is MAC or something else. It takes 4-8 weeks for the culture to grow, be diagnosed as to it's strain, then tested against all the antibiotics to see what will kill it.
We like to call MAC infections "slow to grow and slow to go" – which means the treatment window is long, and there are options. The regimen calls for 3 or 4 antibiotics, taken over a period of at least a year, sometimes longer, and prescribed either 3 times a week or daily. The routine can be difficult, with some people having a lot of side effects from the meds. So, sometimes people who don't tolerate them well, or who don't have a lot of symptoms from the MAC, or who don't have a high level (colony count) of MAC choose not to use the antibiotics. Some people concentrate on airway clearance, using saline solution & coughing exercises, to get as much mucus out as they can, and hope their lungs can begin to heal.
Now come my questions – seeing your Dad's age & conditions, is he a veteran, and is he being treated at a VA facility? It seems many guys from the Viet Nam era have these conditions. If not, did he work in an industry where he was repeatedly exposed to environmental hazards – dust, chemicals, fumes, etc? And is/was he a smoker?
How confident do you and your Dad feel in his care team? This is a complex diagnosis, and really needs to be managed by the same doc or team to get the best results.
Finally, what does your Dad want, given that he is tethered to oxygen 24/7 and has already lost part of a lung? By that I mean, does he want aggressive therapy, and is he up to following a strict set of protocols? How much help does he have at home to handle the routines day to day?