Bacterial Infection: Causes, Symptoms, Treatment & Prevention
Nontuberculous Mycobacterial (NTM) Infection Program
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Initial Evaluation
Diagnosis of NTM infections can be challenging because the symptoms can be similar to other lung diseases, like tuberculosis and lung cancer. Typically, a diagnosis is made by identifying the bacteria in a culture grown from a sputum sample (the substance that's coughed up from the lungs), but other diagnostic tests may be necessary.
Access to prior records and testing is vital to develop a timely, personalized treatment plan. Depending on how recent your previous testing is, we may also coordinate pulmonary function testing and imaging with your initial visit.
Monitoring of Disease
Monitoring nontuberculous mycobacterial (NTM) infections primarily involves clinical evaluation, imaging studies, and microbiologic cultures. By consistently monitoring the disease in these ways, our multi-disciplinary team can make informed decisions about adjusting treatment, assessing the risk of complications, and ultimately improving your health outcomes.
Treatment
Treatment for NTM infections usually involves a combination of antibiotics. The exact medications and length of treatment depend on the type of NTM causing the infection and the patient's overall health. Additional treatments may include pulmonary rehabilitation to improve lung functions. In some cases, surgery may be considered to remove the infected tissue, particularly if the infection is localized to a specific lung area.
UAB Medicine Launches Nontuberculous Mycobacterial Disease Program
Brian Garcia, M.D.
According to the American Lung Association, the number of people living with Nontuberculous Mycobacterial (NTM) lung disease is on the rise, especially among women and older age groups. This bacterial infection can be especially difficult to diagnose, requiring the expertise of a multidisciplinary team the UAB Medicine Nontuberculous Mycobacterial (NTM) Disease Program.
NTM infections arise from organisms commonly found in soil and water, and typically affect those with underlying lung diseases such as COPD or a weakened immune system, causing chronic cough, fatigue, fever, and night sweats. While NTM infections most commonly arise in the lungs, they can also appear in skin or soft tissue infections, lymph nodes, or other organs.
"Some states require public health reporting of NTM infections, but Alabama is not one of them," said Brian Garcia, M.D., medical director of UAB's NTM program. "As a result, this is an under-represented infection at a clinical level and an epidemiologic level."
The NTM Disease program team is comprised of Garcia, German Henostroza, M.D., and Angela Thomas, Nurse Coordinator.
"The number of NTM patients currently in the United States is around 80,000 patients," Garcia explained. "The more elderly patients we have living with chronic lung disease, the more that we will see this infection. Because the organism is so ubiquitous, I tell patients that they will encounter these bacteria no matter what. We see patients with these infections anywhere in their bodies, but 95% of our patients have pulmonary infections."
"There must be a lung infection confirmed either twice in sputum or once in bronchoscopy, radiographic evidence of the disease and symptoms attributed to the infection and that are significant enough that treatment is justified," said Garcia. "Treatment is difficult, typically multiple antibiotics every day for 18 months or longer. That means side effects and drug interactions that must be considered."
Community physicians can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. For more information on resources available at UAB Medicine, visit uabmedicine.Org/physician
Paratek's Antibiotic Succeeds In Phase IIb Lung Disease Trial
Boston-based Paratek Pharmaceuticals has released positive topline data from a Phase IIb trial evaluating its oral antibiotic Nuzyra (omadacycline) in adult patients with nontuberculous mycobacterial (NTM) pulmonary disease.
The therapy showed an improvement in at least 50% of the NTM symptoms present at baseline and no worsening of any baseline symptom. The company was quick to note that "while the study was not designed to formally test for statistical differences between treatment arms, a trend favouring omadacycline was consistently observed across top line primary and secondary endpoints."
Paratek was acquired by Novo Holdings and Gurnet Point in a deal worth approximately $462m in September 2023. Nuzyra is Paratek's lead therapy and is approved by the US Food and Drug Administration (FDA) as a treatment for community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI). GlobalData expects the therapy to generate $119m in 2030.
GlobalData is the parent company of Clinical Trials Arena.
The placebo-controlled Phase IIb trial (NCT04922554) enrolled 66 patients with NTM pulmonary disease caused by mycobacterium abscessus. The study evaluated the primary efficacy endpoint of treatment response on the NTM Symptom Assessment Scale at Day 84 in two ways.
The first evaluation defined a positive response as an improvement in at least 50% of the NTM symptoms present at baseline. The second approach required an improvement in at least 50% of the NTM symptoms present at baseline along with no worsening of any baseline symptom.
In the first evaluation, 34.1% of the participants demonstrated a favourable trend towards higher response rates compared with 20% of the placebo treated subjects. The second evaluation saw 34.1% of the treatment participants showing a favourable trend towards higher response rates compared with 12% of the placebo group.
Nuzyra also showed improvement in microbiological endpoints, with 56.4% of treatment group patients having negative sputum cultures for mycobacterium abscessus compared to 29.2% of the placebo group. At 84 days, 76.5% of the Nuzyra group saw a reduction in semi-quantitative sputum culture scores compared to 45.8% of placebo treated patients.
The common treatment emergent adverse events were gastrointestinal symptoms, with four patients discontinuing treatment due to these. Paratek noted that the study data analysis is ongoing, with the company intending to present and publish complete data at a later date.
"Paratek's antibiotic succeeds in Phase IIb lung disease trial" was originally created and published by Clinical Trials Arena, a GlobalData owned brand.
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