Mycobacterium avium complex (MAC) is the major pathologic nontuberculous mycobacteria causing lung disease (LD) in humans worldwide. Although the burden of MAC-LD has increased over the past two decades, treatment remains difficult because of intolerance of long-term antibiotics, lack of adherence to guidelines, and disease recurrence. The current guidelines recommend antibiotic initiation for patients with MAC-LD and severe disease and in those with disease progression. Thus, physicians should consider antibiotic treatment for patients with MAC-LD and cavitary pulmonary lesions or symptomatic non-cavitary nodular bronchiectasis pattern at initial visits and also for those with clinical deterioration during follow-up. The standard three-drug regimen should be macrolide, rifamycin, and ethambutol. Physicians should monitor side effects in patients and maintain the regimen for 12 months, beginning from when sputum conversion has been obtained. With adherence to guideline-based therapy, treatment is successful in two thirds of treatment-naïve patients without macrolide resistance. Without adherence, macrolide resistance can occur, which leads to poor outcomes in patients with MAC-LD. Although the discovery of new treatment options is warranted, adherence to guidelines remains most crucial in treating patients with MAC-LD. It is worth mentioning that the majority of current recommendations are based on observational studies or small-scale clinical trials.

中文翻译：

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鸟分枝杆菌复杂性肺疾病的治疗。

鸟分枝杆菌复合物（MAC）是导致全球人类肺部疾病（LD）的主要病理性非结核分枝杆菌。尽管MAC-LD的负担在过去的20年中有所增加，但是由于长期使用的抗生素不耐受，缺乏对指南的依从性以及疾病的复发，治疗仍然很困难。当前的指南建议对MAC-LD和重症患者以及疾病进展的患者使用抗生素。因此，医师应在初次就诊时针对MAC-LD和空洞性肺部病变或有症状的非空洞性结节性支气管扩张的患者以及随访期间临床恶化的患者考虑使用抗生素治疗。标准的三药疗法应为大环内酯，利福霉素和乙胺丁醇。从获得痰液转换开始，医师应监测患者的副作用并维持治疗12个月。坚持以指南为基础的治疗，三分之二无大环内酯类抗药性的初治患者均获得成功的治疗。没有依从性，大环内酯类药物可能会发生耐药性，从而导致MAC-LD患者预后不良。尽管有必要发现新的治疗选择，但是在治疗MAC-LD患者中，遵守指南仍然是最关键的。值得一提的是，当前的大多数建议都是基于观察性研究或小型临床试验。在三分之二没有大环内酯耐药性的未接受过治疗的患者中，这种疗法是成功的。没有依从性，大环内酯类药物可能会发生耐药性，从而导致MAC-LD患者预后不良。尽管有必要发现新的治疗选择，但是在治疗MAC-LD患者中，遵守指南仍然是最关键的。值得一提的是，当前的大多数建议都是基于观察性研究或小型临床试验。三分之二无大环内酯类药物治疗的未治疗患者中，治疗成功。没有依从性，大环内酯类药物可能会发生耐药性，从而导致MAC-LD患者预后不良。尽管有必要发现新的治疗选择，但是在治疗MAC-LD患者中，遵守指南仍然是最关键的。值得一提的是，当前的大多数建议都是基于观察性研究或小型临床试验。