When rifampicin resistance is confirmed in Mycobacterium kansasii pulmonary disease, or when a patient cannot tolerate one of the standard first-line antibiotics, the usual first-line approach is not adequate. A different, structured treatment strategy is needed.
This protocol is indicated for patients with rifampicin-resistant Mycobacterium kansasii pulmonary disease — whether rifampicin resistance is confirmed on testing — or for those with documented intolerance to one of the first-line antibiotics.
Management centres on a second-line regimen that incorporates a fluoroquinolone alongside other selected antibiotics. Treatment is required for an extended duration. The full protocol — including the complete combination, agent selection criteria, and duration requirements — is available via the link below.
DOI: 10.1093/cid/ciaa1062
In patients with rifampicin-resistant M. kansasii or intolerance to 1 of the first-line antibiotics we suggest a fluoroquinolone (eg, moxifloxacin) be used as part of a second-line regimen (conditional recommendation, very low certainty in estimates of effect).
For rifampicin-resistant disease, a regimen such as ethambutol, azithromycin, and a fluoroquinolone would be likely to lead to successful treatment.
We suggest that all patients be treated for at least 12 months.
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