Do you treat patients with culture positive mycobacterium abscessus if they are asymptomatic and do not have progression on imaging?

If by "symptomatic," the assumption is that patients have a productive cough, malaise, fatigue, and weight loss, they should be treated per protocol.

We usually proceed with "shared decision making" discussing the nuances of untreated versus treated scenarios.

Treating NTM, particularly M. abscessus, is a complex and challenging process that is prolonged - regardless of the response to therapy. Further, M. abscessus, particularly M. abscessus abscessus, has a high relapse or recurrence rate in addition to a higher likelihood of developing of multi-drug resistance making treatment more difficult.

For M. abscessus abscessus, still the optimal treatment regimen is not clearly defined, particularly for those with macrolide resistance, and patient response is not easily predictable. Challenges with patient adherence, tolerance of prolonged antibiotic therapy, and response necessitate an individualized treatment plan. I agree with Dr. Durrani, "shared decision making" is critical in these scenarios, wi...