What is your preferred third antimicrobial agent for a patient with treatment-naive pulmonary MAC without cavitary disease and strict contraindications to utilization of rifampin or rifabutin?

There’s no clear winner yet. Inhaled liposomal amikacin solution has good potential and the data is trending this way with earlier clearance shown but the long-term outcomes, I believe are still pending. I’m relatively unconvinced or underwhelmed by moxi but as a third drug in the seemingly rare occ...

If there is no macrolide resistance I would cautiously try 2 drug rx. There is a study going on now at Stanford and UCSF, and possibly others looking at this.

Typically, I would choose a third agent in addition to a macrolide and ethambutol such as moxifloxacin or thrice weekly amikacin.

All good answers. However, based on the collective experience at NJH and some (soft) observational data, I generally shy away from FQs. Otherwise, it depends on how accessible and tolerable the third drug is for the patient. I typically recommend:

1. 1. Clofazimine
2. 2. Amikacin Liposome Inhalation Suspe...

Recently had a similar situation, consulted with National Jewish, inhaled amikacin suggested as a reasonable third drug.