MAC Big Three Side Effects

Posted by arbakr @arbakr, Mar 10, 2023

A few months ago I was diagnosed with Primary Immunodeficiency. My body has stopped producing immunoglobulin G. Next week I'll begin infusion therapy to replace it in my body and repair my immune system. About two months later, I learned I have MAC and bronchiectasis. About a month after I start my infusions I'll begin my antibiotics for MAC.

I'm interested in knowing about others' side effects from the big three. I'm also interested in how you manage your side effects. I know this information will really put my mind at ease. Thank you in advance.

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

@label6

Not so much immunity issues, it’s because of our identical body frames. We fit the “classic” description of middle aged, tall, thin female with kyphosis and scoliosis who are most prone to get MAC. She was ahead of me in dx and tx and got eye problems from ethambutol. So my doctor stopped my tx at 6 months since being identical twins, I would get it too. After 3 years I wasn’t doing well, so he started me on them again with the goal of one year. Probably tmi, but it’s nice having this site where we all understand what each us us are going through and can get support.

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What’s do and tx please?

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@lauraadam2425

Hi, I have been on the 3 big ones for mac since August of 2022. Last week I failed my second field eye test and my eye specialist took me immediately off ethambural. The next day I saw my infectious disease Dr and he concurred. I have heard that this is a rare side effect, but one you should be aware of it if you have eye problems. I haven't had the fatigue problem but do have the nausea and have to lay down for 20+ minutes when it is bad. Fortunately I am retired as I am 76 and don't have to deal with fitting work into my schedule anymore. It did take 3 years for them to diagnose me and a loss of 100 lbs. Once I found the right Dr's things got on track and last month I had my first negative cultures which is good since I have tested possitive for 4 different bacterias. I still have to take the meds for another year with NO positive cultures or I start all over!
Good luck and I am hoping you get good results.

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With you testing positive for 4 different bacteria did they diagnose you with both Sarcoidosis and MAC?

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@equanimous

I have bronchiectasis. MAC was discovered about a year ago after my Primary Care dr ordered a chest x ray. Most recently my CT scan showed mucus plugging. I am now on compression vest 2x per day. My pulmonologist wants to hold off on big 3 and is taking the wait and see approach. I have 3 friends who have lost hearing due to antibiotics. I am a musician and this scares the heck out of me! I am grateful to have found this group.

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Welcome to Mayo Connect. It seems overwhelming when we first get this diagnosis, but trust me things do get better over time.
I'm going to try to answer several of your questions, but would invite @poodledoc, @irenea8 and other "veterans" to weigh in with their experiences.

First, the vest should be a help with airway clearance, but if you are trying to avoid the antibiotics, I would suggest that you also ask about nebulizing 7% saline, which has the dual advantage of thinning mucus and potentially suppressing the bacteria growth. Here is an article to introduce you to it:https://smartvest.com/blog/airway-clearance-techniques-for-bronchiectasis-and-copd/

Second, most of us were told that outdoor pools are safe. Chlorine does not kill MAC so it lingers in the copious water vapors above an indoor pool or any hotub, so these are to be avoided.

Finally, not everyone experiences hearing loss from the drugs - I got my a baseline hearing test, then was tested by an audiologist every 3 months to be sure, since I already have issues with tinnitus and age-related loss. So if you need to start, just be hypervigilant.

If you spend some time reading other discussions in this support group, you will find the answers to many of your questions.
Sue

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@criggyf1

I was just diagnosed with MAI and my pulmonologist hasn’t told me to begin this but would you do so? I’ve also read to take short, mild showers and that is going to really suck! but should I do this also? Thank you so much Sue. You were the 1st to reply to me and I value your opinion.

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Hi, if I was not advised to do airway clearance, I would first call my pulmonologist and ask for a respiratory therapy consult to demonstrate. Then I would read this article:
https://smartvest.com/blog/airway-clearance-techniques-for-bronchiectasis-and-copd/
and Google for Airway Clearance techniques on YouTube.
If the pulmonologist said "not necessary" I would find a new doc - this is the cornerstone of managing bronchiectasis and controlling the mucus that harbors bacteria.
Sue

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@equanimous

I have recently been doing a water aerobics class and read about MAC being chlorine resistant. I wrote my dr to ask if I should d/c pool activity. She said if the pool is well maintained it is okay. I just want to be sure....Does anyone know, if you are already diagnosed with MAC, can going to a pool make it worse?

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I was never told that pools are a problem. They did say never on saunas, steam baths, jacuzzis. Saunas are apparently germ baths for anyone not just us MAC people. Hope that swimming is ok, because it’s such great exercise for lungs etc.

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@susanlo

I understand the mycobacteria is everywhere and in everything all of us are exposed to on a daily basis. Maybe it’s a moot point after you are already infected, but research on particulars, ie: are there clusters in specific areas, are there more verified cases in one state as compared to others, is there a way to negate reinfection-short of moving to another area, etc., these things could affect how and where you live. Should you use protection (such as a mask and gloves) when working outside, should your water be tested(as I’ve read some bacteria can thrive in certain types of water pipes), and followups on peoples’ health who have undergone treatment.
I did not join this site to express or defend my thoughts on research and it’s funding of MAC, and there is so much unknown about it, but I do believe having as much knowledge as possible is important and that is evidenced here with all of the great information shared among the many participants.

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Based on my journey since 2015 and what I know. ..I have had all of these questions for many years and have found few answers. Basically we are in a population of people in which there is little/no interest in giving research money to! The AIDS epidemic gave more research into MAC because they found that population started getting MAC/NTM more. Not much went forward decor we still know it’s more prevalent in low immune systems. My personal belief is that it is just not widely tested still at all. It is found to be more prevalent in certain communities for example in Hawaii. Well is that because of Hawaii or astute doctors and/or active health advocates in NTM/MAC community? Most doctors other than most pulmonologists don’t even know what MAC/NTM is. They have too much wise on their plate. I think until the MAX/NTM community gets active advocating it goes nowhere. I feel I’m in a secret society of medical unknowns and only know 5 people in my world who have it and that’s after much reaching out quietly to my doctors sharing my personal info and giving pet
Issuin for them to share my info so we can share info. Knowledge is power!

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@sueinmn

Other people who are susceptible (besides those with Bronchiectasis) include people with other lung diseases such as Cystic Fibrosis and Emphysema, people with compromised immune systems, and in some cases, people who have had lung surgery.

Airway clearance helps eject the mucus (and the germs it contains) from our compromised lungs to prevent colonies from growing. Normal lungs are able to do this with routine coughing and throat clearing. For me, it is the most important part of staying healthy.
Sue

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Agree!!! Airway clearance is sooo important!

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@sueinmn

Welcome to Mayo Connect. It seems overwhelming when we first get this diagnosis, but trust me things do get better over time.
I'm going to try to answer several of your questions, but would invite @poodledoc, @irenea8 and other "veterans" to weigh in with their experiences.

First, the vest should be a help with airway clearance, but if you are trying to avoid the antibiotics, I would suggest that you also ask about nebulizing 7% saline, which has the dual advantage of thinning mucus and potentially suppressing the bacteria growth. Here is an article to introduce you to it:https://smartvest.com/blog/airway-clearance-techniques-for-bronchiectasis-and-copd/

Second, most of us were told that outdoor pools are safe. Chlorine does not kill MAC so it lingers in the copious water vapors above an indoor pool or any hotub, so these are to be avoided.

Finally, not everyone experiences hearing loss from the drugs - I got my a baseline hearing test, then was tested by an audiologist every 3 months to be sure, since I already have issues with tinnitus and age-related loss. So if you need to start, just be hypervigilant.

If you spend some time reading other discussions in this support group, you will find the answers to many of your questions.
Sue

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Thank you so very much. This helps alot!

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Amikacin by IV. Mine was administered at the hospital infusion lab 3 times per week. It takes an hour. I made my appointments at 11:40 so the fed me a free lunch each day. It was very expensive, $50 for the medicine but $700 to administer it each day, so over $25000. I did OK until the 5th or 6th week then went extremely dizzy to the point of winding up in the ER for suspicion of a stroke. The Dr cut the dosage from 500mg to 400mg and it was a little better, but I could not drive, etc. Once the 12 weeks was up, the dizziness went away,thank God. I did suffer from some Tinnitus also. Did it help? No definitive answer was ever given.

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@pawster

I was never told that pools are a problem. They did say never on saunas, steam baths, jacuzzis. Saunas are apparently germ baths for anyone not just us MAC people. Hope that swimming is ok, because it’s such great exercise for lungs etc.

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Thank you so very much. This is great news!

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