Taking other medications in addition to antibiotics for NTN

I never took many different meds but when I took esomeprazole I took it am when inhaling sodium chloride so about an hour before breakfast. The MAC meds I took all at night. If you have a good pharmacist you can ask him/her- mine is always helpful.

@sheridanm - @lilianna gave you the best advice - talk to your pharmacist. Not all meds need to be spaced out from the antibiotics, but pharmacists are the best equipped to answer your specific questions. Be sure to tell them all over-the-counter items you use, including supplements.

As for timing, like lilianna, I took all of mine in the evening - primarily because they caused a lot of nausea and I could sleep through it. But not too close to bedtime.

Did your doctor provide dosing instructions?

Also if I remember well, ethambutol cannot be taken with calcium rich food such as yogurt which I did until I learned that. Please check this.

@lilianna Interesting, since my instructions are to take ethambutol and azithromycin two hours before bedtime with a bowl of ice cream. My husband said, “A bowl, not just a little scoop?” The doctor replied, "Yes, a bowl.” One could go crazy trying to follow ALL the guidelines!

I just read a post from lenorj this morning that I think you should check out. The post is titled: "Two drugs theee days a week for MAC. Anyone have this experience? Lenorj's Dr at NYU Langone is saying that MAC is now treated with 2 meds 3 days per week vs the old 3 drug daily method. Also, you mentioned you have NTM, do you have MAC? NTM is a broad term. I was diagnosed with MABC-which is harder to get rid of than MAC but still when I went to NJH, they suggested one of the 3 meds I was on be reduced to 3/week and another drug dose cut in half. My ID doctor put me on the MABC meds prematurely and I didn't realize this until I went to NJH. The first week, they reduced my drugs in half (after being on 3 weeks) and by the 2nd week, I was told my count was so low that they would not have started me on any antibiotics. Are you being seen by a Dr at a BE-NTM clinic? There have been quite a few posts in regards to finding certified BE NTM clinics. I'm just curious if your dos can be adjusted or cut in half or more?

I also see one of the NYU BE/MAC experts and I have heard from them that studies are now supporting "Big 2" (skipping rifampin) and/or 3 doses/ week. BUT I would research more or ask more questions since, for example, they have suggested they might recommend I stay on maintenance antibiotics since I did not clear MAC after 11 months of treatment ... Right now I'm in a 3-month watch and wait without treatment to see if the mild hearing loss I had, presumably from the meds, reverses or stabilizes.
So I would want to understand better whether protocols overall are moving toward 3x/week or if this might right now be suggested under more limited circumstances.

@lvnl & @kathyjjb There are numerous protocols for treatment. Some use 2 drugs (often based on sensitivity testing), some adding Arikayce or another drug right away. The decision between 7-day and 3-day dosing may be made based on severity of the infection, or what strain of NTM is being treated.

The usual protocol for beginning antibiotic treatment for MAC has been 3 times weekly for many years. My personal observation is that some ID docs not working in conjunction with a MAC-knowledgeable pulmonologist are more likely prescribe daily meds. I'm not sure why this is the case, but sometimes when that person gets to an expert pulmonologist, the dosage is cut back to 3 times a week.

If you want to see the published protocol from 2020, look at the table on page 20 of this document:
https://ntminfo.org/wp-content/uploads/2020/07/NTMguidelines2020.pdf
New guidelines are coming, here is a preview that has not yet been published for the US:
https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.202408-904FR
It says, in part, "For less severe noncavitary NB disease, a thrice-weekly regimen is often adopted for its effectiveness and better tolerability than daily treatment."

@sueinmn The article from the ATS Journal is very interesting. It may be the solution to my dilemma for wanting to take low dose macrolides during flu season due to frequent BE exacerbations. Brensocatib is not an option for me. The recommendation is that low dose Erythromycin be used since "it has no activity against MAC (didn't mention MABC) and shouldn't result in macrolide resistance". I also see that some of Charles Daley's publications were referenced in the article, so fairly certain my NJH ID doctor is up to speed on all of this. Thanks for posting!