Guidelines for chemotherapy of pulmonary nontuberculous mycobacterial disease--2012 revised version.

In 2008, the Nontuberculous Mycobacteriosis Control Committee of the Japanese Society for Tuberculosis and the Scientifi c Assembly for Infection and Tuberculosis of the Japanese Respiratory Society (hereinafter, the Joint Guidelines Committee) published the Guidelines for chemotherapy of pulmonary nontuberculous mycobacterial disease─2008 interim guidelines 1). In the background, rifabutin (RBT) and clarithromycin (CAM) were approved for Japanese medical insurance coverage in August of that year for the treatment of pulmonary nontuberculous mycobacterial diseases. Headed by the American Thoracic Society (ATS) offi cial guidelines2) 3), since the 1990s the worldwide standard chemotherapy for pulmonary Mycobacterium avium complex (MAC) disease has been based on oral triple therapy with CAM, rifampicin (RFP) or RBT, and ethambutol (EB), with the addition of intramuscular injections of an aminoglycoside for the fi rst 2 to 3 months in severe cases. However, in Japan there were no pharmacological agents with offi cial approval for the treatment of pulmonary nontuberculous mycobacterial diseases until 2008, so the Societies were unable to publish any therapeutic regimens as offi cial guidelines. Accordingly, the 2008 interim guidelines represented a revolutionary change in the clinical management of pulmonary nontuberculous mycobacterial diseases in Japan. However, at the time the 2008 interim guidelines were published neither RFP nor EB were offi cially approved for Japanese medical insurance coverage for the treatment of pulmonary nontuberculous mycobacterial diseases, and circumstances dictated that dosages had to be expressed ambiguously. Following the efforts of various concerned parties, RFP and EB gained offi cial approval in May 2011, leading to these updated guidelines revising the 2008 interim guidelines. In these guidelines, in addition to pulmonary MAC disease we will recommend a chemotherapy regimen for M.kansasii disease. Pulmonary M.kansasii disease is the most responsive to chemotherapy of all pulmonary nontuberculous mycobacterial diseases, and the therapeutic regimens are relatively GUIDELINES FOR CHEMOTHERAPY OF PULMONARY NONTUBERCULOUS MYCOBACTERIAL DISEASE ─2012 Revised Version