Nontuberculosis mycobacteria infections: would there be pharmacodynamics without pharmacokinetics?

We read with great interest the recent publication by Kwak et al. [1] involving a meta-analysis of studies reporting treatment outcomes for Mycobacterium abscessus pulmonary disease (MAB-PD). The authors should be commended for identifying the association between azithromycin, amikacin and imipenem, and improved clinical outcome in MAB-PD.

M. abscessus, together with M. aviumcomplex (MAC) and M. kansasii, is one of the most common and difficult to treat nontuberculous mycobacteria (NTM) species associated with pulmonary disease [2]. Treatment regimen for NTM infections is largely empirical and driven by clinical experience. Without sound pharmacokinetic (PK)- and pharmacodynamic (PD)-based guidelines on dose, frequency, dose adjustment or monitoring, clinicians are left with uncertainties when it comes to the specifics of prescribing a drug regimen. There is a great need for evidence-based dosing and monitoring strategies.